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Cao M, Sheng R, Sun Y, Cao Y, Wang H, Zhang M, Pu Y, Gao Y, Zhang Y, Lu P, Teng G, Wang Q, Rui Y. Delivering Microrobots in the Musculoskeletal System. NANO-MICRO LETTERS 2024; 16:251. [PMID: 39037551 PMCID: PMC11263536 DOI: 10.1007/s40820-024-01464-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/16/2024] [Indexed: 07/23/2024]
Abstract
Disorders of the musculoskeletal system are the major contributors to the global burden of disease and current treatments show limited efficacy. Patients often suffer chronic pain and might eventually have to undergo end-stage surgery. Therefore, future treatments should focus on early detection and intervention of regional lesions. Microrobots have been gradually used in organisms due to their advantages of intelligent, precise and minimally invasive targeted delivery. Through the combination of control and imaging systems, microrobots with good biosafety can be delivered to the desired area for treatment. In the musculoskeletal system, microrobots are mainly utilized to transport stem cells/drugs or to remove hazardous substances from the body. Compared to traditional biomaterial and tissue engineering strategies, active motion improves the efficiency and penetration of local targeting of cells/drugs. This review discusses the frontier applications of microrobotic systems in different tissues of the musculoskeletal system. We summarize the challenges and barriers that hinder clinical translation by evaluating the characteristics of different microrobots and finally point out the future direction of microrobots in the musculoskeletal system.
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Affiliation(s)
- Mumin Cao
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
- School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, People's Republic of China
| | - Renwang Sheng
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
- School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, People's Republic of China
| | - Yimin Sun
- Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, School of Mechanical Engineering, Southeast University, Nanjing, 210009, People's Republic of China
| | - Ying Cao
- Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, School of Mechanical Engineering, Southeast University, Nanjing, 210009, People's Republic of China
| | - Hao Wang
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
- School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, People's Republic of China
| | - Ming Zhang
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
- School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, People's Republic of China
| | - Yunmeng Pu
- School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
| | - Yucheng Gao
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
- School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, People's Republic of China
| | - Yuanwei Zhang
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
- School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, People's Republic of China
| | - Panpan Lu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China
- School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, People's Republic of China
| | - Gaojun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China.
| | - Qianqian Wang
- Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, School of Mechanical Engineering, Southeast University, Nanjing, 210009, People's Republic of China.
| | - Yunfeng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People's Republic of China.
- School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China.
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, 210009, People's Republic of China.
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Taylor WJ, Willink R, O’Connor DA, Patel V, Bourne A, Harris IA, Whittle SL, Richards B, Clavisi O, Green S, Hinman RS, Maher CG, Cahill A, McPherson A, Hewson C, May SE, Walker B, Robinson PC, Ghersi D, Fitzpatrick J, Winzenberg T, Fallon K, Glasziou P, Billot L, Buchbinder R. Which clinical research questions are the most important? Development and preliminary validation of the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network Research Question Importance Tool (ANZMUSC-RQIT). PLoS One 2023; 18:e0281308. [PMID: 36930668 PMCID: PMC10022765 DOI: 10.1371/journal.pone.0281308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/20/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND AND AIMS High quality clinical research that addresses important questions requires significant resources. In resource-constrained environments, projects will therefore need to be prioritized. The Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network aimed to develop a stakeholder-based, transparent, easily implementable tool that provides a score for the 'importance' of a research question which could be used to rank research projects in order of importance. METHODS Using a mixed-methods, multi-stage approach that included a Delphi survey, consensus workshop, inter-rater reliability testing, validity testing and calibration using a discrete-choice methodology, the Research Question Importance Tool (ANZMUSC-RQIT) was developed. The tool incorporated broad stakeholder opinion, including consumers, at each stage and is designed for scoring by committee consensus. RESULTS The ANZMUSC-RQIT tool consists of 5 dimensions (compared to 6 dimensions for an earlier version of RQIT): (1) extent of stakeholder consensus, (2) social burden of health condition, (3) patient burden of health condition, (4) anticipated effectiveness of proposed intervention, and (5) extent to which health equity is addressed by the research. Each dimension is assessed by defining ordered levels of a relevant attribute and by assigning a score to each level. The scores for the dimensions are then summed to obtain an overall ANZMUSC-RQIT score, which represents the importance of the research question. The result is a score on an interval scale with an arbitrary unit, ranging from 0 (minimal importance) to 1000. The ANZMUSC-RQIT dimensions can be reliably ordered by committee consensus (ICC 0.73-0.93) and the overall score is positively associated with citation count (standardised regression coefficient 0.33, p<0.001) and journal impact factor group (OR 6.78, 95% CI 3.17 to 14.50 for 3rd tertile compared to 1st tertile of ANZMUSC-RQIT scores) for 200 published musculoskeletal clinical trials. CONCLUSION We propose that the ANZMUSC-RQIT is a useful tool for prioritising the importance of a research question.
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Affiliation(s)
- William J. Taylor
- University of Otago, Wellington, New Zealand
- Hutt Valley District Health Board, Lower Hutt, New Zealand
- Hauora Tairawhiti, Gisborne, New Zealand
- * E-mail:
| | | | - Denise A. O’Connor
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Victoria, Australia
| | - Vinay Patel
- University of Otago, Wellington, New Zealand
| | - Allison Bourne
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Victoria, Australia
| | - Ian A. Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia
- School of Clinical Medicine, UNSW Sydney, Liverpool, NSW, Australia
- Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Samuel L. Whittle
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Bethan Richards
- School of Clinical Medicine, UNSW Sydney, Liverpool, NSW, Australia
- Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Sally Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rana S. Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Chris G. Maher
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, Sydney, NSW, Australia
| | | | | | | | | | - Bruce Walker
- Emeritus Professor in the College of Science, Health, Engineering and Education (SHEE), Murdoch University, Murdoch, WA, Australia
| | | | - Davina Ghersi
- National Health and Medical Research Council of Australia, Canberra, ACT, Australia
| | | | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Kieran Fallon
- ANU College of Health and Medicine, Australian National University, Garran, ACT, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Laurent Billot
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Victoria, Australia
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Paskins Z, Farmer CE, Manning F, Andersson DA, Barlow T, Bishop FL, Brown CA, Clark A, Clark EM, Dulake D, Gulati M, Le Maitre CL, Jones RK, Loughlin J, Mason DJ, McCarron M, Millar NL, Pandit H, Peat G, Richardson SM, Salt EJ, Taylor EJ, Troeberg L, Wilcox RK, Wise E, Wilkinson C, Watt FE. Research priorities to reduce the impact of musculoskeletal disorders: a priority setting exercise with the child health and nutrition research initiative method. THE LANCET. RHEUMATOLOGY 2022; 4:e635-e645. [PMID: 36275038 PMCID: PMC9584828 DOI: 10.1016/s2665-9913(22)00136-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Involving research users in setting priorities for research is essential to ensure the outcomes are patient-centred and maximise its value and impact. The Musculoskeletal Disorders Research Advisory Group Versus Arthritis led a research priority setting exercise across musculoskeletal disorders. The Child Health and Nutrition Research Initiative (CHNRI) method of setting research priorities with a range of stakeholders was used, involving four stages and two surveys, to: (1) gather research uncertainties, (2) consolidate these, (3) score uncertainties against importance and impact, and (4) analyse scoring for prioritisation. 213 people responded to the first survey and 285 people to the second, representing clinicians, researchers, and people with musculoskeletal disorders. Key priorities included developing and testing new treatments, better treatment targeting, early diagnosis, prevention, and better understanding and management of pain, with an emphasis on understanding underpinning mechanisms. We present a call to action to researchers and funders to target these priorities.
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Affiliation(s)
- Zoe Paskins
- Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | | | - Fay Manning
- School of Medicine, Keele University, Keele, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David A Andersson
- Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tim Barlow
- Department of Orthopaedics, Wrightington Hospital, Wigan, UK
| | | | | | | | - Emma M Clark
- Bristol Medical School, University of Bristol, UK
| | | | - Malvika Gulati
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Richard K Jones
- Centre for Health Sciences Research, University of Salford, Manchester, UK
| | - John Loughlin
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Maura McCarron
- Department of Rheumatology, Belfast Health and Social Care Trust, Belfast, UK
| | - Neil L Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - George Peat
- Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Stephen M Richardson
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Emma J Salt
- Primary Care Centre Versus Arthritis, Keele University, Keele, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Linda Troeberg
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Elspeth Wise
- Talbot Medical Centre, South Shields & Primary Care Rheumatology and Musculoskeletal Medicine Society, South Shields, UK
| | | | - Fiona E Watt
- Department of Immunology and Inflammation, Imperial College London, London, UK
- Correspondence to: Dr Fiona E Watt, Department of Immunology and Inflammation, Hammersmith Campus, Imperial College London, London W12 0NN, UK
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Falsiroli Maistrello L, Zanconato L, Palese A, Geri T, Turolla A, Gianola S, Dell’Isola A, Rossettini G. Perceptions and Experiences of Individuals With Neck Pain: A Systematic Critical Review of Qualitative Studies With Meta-Summary and Meta-Synthesis. Phys Ther 2022; 102:6609052. [PMID: 35708498 PMCID: PMC9384136 DOI: 10.1093/ptj/pzac080] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/22/2022] [Accepted: 05/23/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This study aimed at exploring the perspectives and experiences of individuals with neck pain by synthesizing all available qualitative studies. METHODS A systematic, qualitative meta-summary and meta-synthesis was conducted following the 5-step methodology proposed by Sandelowski and Barroso. A systematic search of 9 electronic databases was conducted in May 2021. Methodological quality was assessed using the Critical Appraisal Skills Programme tool. RESULTS Nine studies were included in the meta-synthesis for a total of 103 participants (73 women). Eleven categories were identified as belonging to 3 main themes: physical ("My neck has gone wrong"); psychological ("I am worried about my recovery"); and social ("Pain limits my life"). In the physical theme, the categories with the highest frequency were symptoms (67%) followed by body perception (44%). The psychological theme frequencies from highest to lowest were psychological consequences (100%), coping strategies (100%), mindset (67%), expectations from health care professionals (44%), and gender influence (22%). In the social theme, frequencies from highest to lowest were social relationships (56%), work, and activities of daily living and physical activity (44%, respectively). CONCLUSION An individual's experience with neck pain is a multidimensional phenomenon in which physical, psychological, and social dimensions influence each other. These findings suggested that health care professionals should be aware of recognizing and evaluating all of the individual's experiences to offer a truly patient-centered care pathway. IMPACT This qualitative meta-synthesis responded to a call to action to explore perspectives and experiences of individuals with neck pain. These findings can provide crucial guidance for clinicians as they plan and implement evidence-based recommendations for neck pain.
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Affiliation(s)
- Luca Falsiroli Maistrello
- School of Physiotherapy, University of Verona, Verona, Italy,Department of Physical Medicine and Rehabilitation, AULSS9 Scaligera, G. Fracastoro Hospital, San Bonifacio, Verona, Italy
| | | | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
| | | | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences DIBINEM, Alma Mater University of Bologna, Bologna, Italy,Division of Occupational Medicine, Sant’Orsola-Malpighi Hospital IRCCS, Bologna, Italy
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Andrea Dell’Isola
- Clinical Epidemiology Unit, Department of Clinical Sciences, Orthopaedic, Faculty of Medicine, Lund University, Lund, Sweden,Address all correspondence to Dr Dell’Isola at:
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Nemeh F, Buchbinder R, Hawley CM, Nelson MR, Waterkeyn JG, Reid CM. Activities supporting the growth of Clinical Trial Networks in Australia. Trials 2022; 23:81. [PMID: 35090533 PMCID: PMC8795956 DOI: 10.1186/s13063-021-05974-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/21/2021] [Indexed: 01/20/2023] Open
Abstract
Clinical Trial Networks in which trialists work collaboratively enable multi-site, large-scale, high-quality clinical trials to be efficiently run. Although the benefits of Clinical Trial Networks are largely known, establishing a Clinical Trial Network can be complex. There are many factors for clinicians and researchers to consider, and there is currently a paucity of information on how to form a Clinical Trial Network. This article provides a suggested roadmap on how to establish a Clinical Trial Network. The Australian Clinical Trials Alliance (ACTA) is the peak body for Clinical Trial Networks, Coordinating Centres and Registries in Australia, and has produced several resources to support the effective and efficient running of clinical trials. This guide has come about through discussions with members of the ACTA Clinical Trial Network Sector Expansion Reference Group consisting of clinical trialists, clinicians, researchers, and consumers.
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Affiliation(s)
- Fiona Nemeh
- Australian Clinical Trials Alliance, Melbourne, Victoria, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Mark R Nelson
- Australian Clinical Trials Alliance, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Christopher M Reid
- Australian Clinical Trials Alliance, Melbourne, Victoria, Australia. .,School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia. .,School of Public Health, Curtin University, Bentley, Western Australia, Australia.
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Diarbakerli E, Thoreson O, Björklund M, Dahlberg LE, Englund M, Gerdhem P, Kvist J, Mohaddes M, Peolsson A, Rolfson O, Öberg B, Abbott A. Learning from the past to plan for the future: A scoping review of musculoskeletal clinical research in Sweden 2010-2020. Ups J Med Sci 2022; 127:8709. [PMID: 36337277 PMCID: PMC9602198 DOI: 10.48101/ujms.v127.8709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The aims of this study are to 1) determine the scope of musculoskeletal (MSK)-related clinical research in Sweden; 2) collate the amount of first-tier funding received; 3) discuss strategies and infrastructure supporting future MSK clinical trials in Sweden. METHODS A systematic scoping review protocol was applied in PubMed, Scopus, and SweCRIS databases. The articles were examined, and data were extracted in multiple stages by three blinded authors. RESULTS The search strategy resulted in 3,025 publications from 479 Swedish-affiliated authors. Primary health care was the basis for 14% of the publications, 84% from secondary health care, and 2% from occupational health care with a similar proportional distribution of first-tier research grant financing. Approximately one in six publications were randomized controlled trials (RCTs), while the majority were of observational cohort design. The majority of publications in primary and occupational health care were related to pain disorders (51 and 67%, respectively), especially diagnosis, prognosis, and healthcare organizational-related interventions (34%) and rehabilitation (15%) with similar proportional distribution of first-tier research grant financing. In secondary health care, rheumatic inflammatory disorder-related publications were most prevalent (30%), most frequently concerning diagnosis, prognosis, and healthcare organizational-related interventions (20%), attracting approximately half of all first-tier funding. Publications related to degenerative joint disorders (25%), fractures (16%), and joint, tendon, and muscle injuries (13%) frequently concerned surgical and other orthopedic-related interventions (16, 6, and 8%, respectively). Pain disorder-related publications (10%) as well as bone health and osteoporosis-related publications (4%) most frequently concerned diagnosis, prognosis, and healthcare organizational-related interventions (5 and 3%, respectively). CONCLUSIONS Swedish-affiliated MSK disorder research 2010-2020 was predominantly observational cohort rather than RCT based. There was skewed first-tier funding allocation considering prevalence/incidence and burden of disease. Use of infrastructure supporting register-based RCTs, placebo-controlled RCTs, and hybrid effectiveness-implementation studies on prevention and clinical intervention is important strategies for the future in all healthcare sectors.
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Affiliation(s)
- Elias Diarbakerli
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Thoreson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Björklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Leif E Dahlberg
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Paul Gerdhem
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Joanna Kvist
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine & Surgery, Karolinska Institute, Solna, Sweden
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University
| | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University
- Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University
- Department of Orthopaedics, Linköping University Hospital, SE 581 83 Linköping, Sweden
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Asensio G, Benito-Garzón L, Ramírez-Jiménez RA, Guadilla Y, Gonzalez-Rubio J, Abradelo C, Parra J, Martín-López MR, Aguilar MR, Vázquez-Lasa B, Rojo L. Biomimetic Gradient Scaffolds Containing Hyaluronic Acid and Sr/Zn Folates for Osteochondral Tissue Engineering. Polymers (Basel) 2021; 14:12. [PMID: 35012034 PMCID: PMC8747647 DOI: 10.3390/polym14010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 12/24/2022] Open
Abstract
Regenerative therapies based on tissue engineering are becoming the most promising alternative for the treatment of osteoarthritis and rheumatoid arthritis. However, regeneration of full-thickness articular osteochondral defects that reproduces the complexity of native cartilage and osteochondral interface still remains challenging. Hence, in this work, we present the fabrication, physic-chemical characterization, and in vitro and in vivo evaluation of biomimetic hierarchical scaffolds that mimic both the spatial organization and composition of cartilage and the osteochondral interface. The scaffold is composed of a composite porous support obtained by cryopolymerization of poly(ethylene glycol) dimethacrylate (PEGDMA) in the presence of biodegradable poly(D,L-lactide-co-glycolide) (PLGA), bioactive tricalcium phosphate β-TCP and the bone promoting strontium folate (SrFO), with a gradient biomimetic photo-polymerized methacrylated hyaluronic acid (HAMA) based hydrogel containing the bioactive zinc folic acid derivative (ZnFO). Microscopical analysis of hierarchical scaffolds showed an open interconnected porous open microstructure and the in vitro behaviour results indicated high swelling capacity with a sustained degradation rate. In vitro release studies during 3 weeks indicated the sustained leaching of bioactive compounds, i.e., Sr2+, Zn2+ and folic acid, within a biologically active range without negative effects on human osteoblast cells (hOBs) and human articular cartilage cells (hACs) cultures. In vitro co-cultures of hOBs and hACs revealed guided cell colonization and proliferation according to the matrix microstructure and composition. In vivo rabbit-condyle experiments in a critical-sized defect model showed the ability of the biomimetic scaffold to promote the regeneration of cartilage-like tissue over the scaffold and neoformation of osteochondral tissue.
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Affiliation(s)
- Gerardo Asensio
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, Calle Juan de la Cierva 3, 28006 Madrid, Spain; (G.A.); (R.A.R.-J.); (M.R.A.); (B.V.-L.)
| | - Lorena Benito-Garzón
- Departamento de Anatomía e Histología Humanas, Facultad de Medicina, Universidad de Salamanca, 37007 Salamanca, Spain;
| | - Rosa Ana Ramírez-Jiménez
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, Calle Juan de la Cierva 3, 28006 Madrid, Spain; (G.A.); (R.A.R.-J.); (M.R.A.); (B.V.-L.)
| | - Yasmina Guadilla
- Departamento de Cirugía, Facultad de Medicina, Universidad de Salamanca, 37007 Salamanca, Spain;
| | - Julian Gonzalez-Rubio
- Departamento de Química y Bioquímica, Facultad de Farmacia, Universidad San Pablo-CEU, Urbanización Montepríncipe, CEU Universities, 28925 Alcorcon, Spain; (J.G.-R.); (C.A.)
| | - Cristina Abradelo
- Departamento de Química y Bioquímica, Facultad de Farmacia, Universidad San Pablo-CEU, Urbanización Montepríncipe, CEU Universities, 28925 Alcorcon, Spain; (J.G.-R.); (C.A.)
| | - Juan Parra
- Unidad Asociada de I+D al CSIC Unidad de Investigación Clínica y Biopatología Experimental, Complejo Asistencial de Ávila, SACYL, 05003 Avila, Spain; (J.P.); (M.R.M.-L.)
- Centro de Investigación Biomédica en Red de Bioingienería, Biomateriales y Biotecnología CIBER-BBN, Instituto de Salud Carlos III, Calle Monforte de Lemos S/N, 28029 Madrid, Spain
| | - María Rocío Martín-López
- Unidad Asociada de I+D al CSIC Unidad de Investigación Clínica y Biopatología Experimental, Complejo Asistencial de Ávila, SACYL, 05003 Avila, Spain; (J.P.); (M.R.M.-L.)
| | - María Rosa Aguilar
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, Calle Juan de la Cierva 3, 28006 Madrid, Spain; (G.A.); (R.A.R.-J.); (M.R.A.); (B.V.-L.)
- Centro de Investigación Biomédica en Red de Bioingienería, Biomateriales y Biotecnología CIBER-BBN, Instituto de Salud Carlos III, Calle Monforte de Lemos S/N, 28029 Madrid, Spain
| | - Blanca Vázquez-Lasa
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, Calle Juan de la Cierva 3, 28006 Madrid, Spain; (G.A.); (R.A.R.-J.); (M.R.A.); (B.V.-L.)
- Centro de Investigación Biomédica en Red de Bioingienería, Biomateriales y Biotecnología CIBER-BBN, Instituto de Salud Carlos III, Calle Monforte de Lemos S/N, 28029 Madrid, Spain
| | - Luis Rojo
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, Calle Juan de la Cierva 3, 28006 Madrid, Spain; (G.A.); (R.A.R.-J.); (M.R.A.); (B.V.-L.)
- Centro de Investigación Biomédica en Red de Bioingienería, Biomateriales y Biotecnología CIBER-BBN, Instituto de Salud Carlos III, Calle Monforte de Lemos S/N, 28029 Madrid, Spain
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8
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Taylor K, Baxter GD, Tumilty S. Clinical decision-making for shoulder surgery referral: An art or a science? J Eval Clin Pract 2021; 27:1159-1163. [PMID: 32941698 DOI: 10.1111/jep.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Abstract
RATIONALE Decision-making in musculoskeletal health care is complex, with discrepancy among clinical providers and variation in the per cent of referrals for specialist care. To date, there is an increased focus on specialist referrals, risking overuse of expensive testing and contributing to unnecessary treatment. AIMS AND OBJECTIVES This report will considerer the difficulties of primary care musculoskeletal decision-making using shoulder injuries as an example, presenting a solution based on multi-criteria decision-making analysis with online software. The associated issues involved in clinical decision-making are complex. Contributing to the components of complexity are; the multifaceted aetiology of shoulders, the experience and knowledge of providers, and the burden of patient demands. Notwithstanding, funding considerations, resource allocation availability and other associated issues around clinical decision-making. Considering the many facets and complexities of clinical decision-making, this is an area where multi-criteria decision-making analysis (MCDM) may be appropriate. The MCDM analysis approach is increasingly being used in health care and can assist in the organizing and weighting of identified key clinical factors. MCDM could be applied to the challenges of musculoskeletal care with the potential to decrease decision-making variability. Furthermore, the significance of each key clinical factor that musculoskeletal decision-making is based on are to date unclear. CONCLUSION Therefore, this preliminary report offers a start towards clarifying key factors and an approach for implementing improved shoulder clinical care decision-making which could then be adapted and applied to other body sites.
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Affiliation(s)
- Karen Taylor
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - George D Baxter
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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9
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Gwilym SE, Perry DC, Costa ML. Trauma and orthopaedic research is being driven by priorities identified by patients, surgeons, and other key stakeholders. Bone Joint J 2021; 103-B:1328-1330. [PMID: 34334051 PMCID: PMC9987161 DOI: 10.1302/0301-620x.103b8.bjj-2020-2578.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Stephen E Gwilym
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Daniel C Perry
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Matt L Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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10
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Headache and musculoskeletal pain in school children are associated with uncorrected vision problems and need for glasses: a case-control study. Sci Rep 2021; 11:2093. [PMID: 33483534 PMCID: PMC7822909 DOI: 10.1038/s41598-021-81497-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 01/04/2021] [Indexed: 01/15/2023] Open
Abstract
Musculoskeletal pain and headache are leading causes of years lived with disability, and an escalating problem in school children. Children spend increasingly more time reading and using digital screens, and increased near tasks intensify the workload on the precise coordination of the visual and head-stabilizing systems. Even minor vision problems can provoke headache and neck- and shoulder (pericranial) pain. This study investigated the association between headaches, pericranial tenderness, vision problems, and the need for glasses in children. An eye and physical examination was performed in twenty 10–15 year old children presenting to the school health nurse with headache and pericranial pain (pain group), and twenty age-and-gender matched classmates (control group). The results showed that twice as many children in the pain group had uncorrected vision and needed glasses. Most children were hyperopic, and glasses were recommended mainly for near work. Headache and pericranial tenderness were significantly correlated to reduced binocular vision, reduced distance vision, and the need for new glasses. That uncorrected vision problems are related to upper body musculoskeletal symptoms and headache, indicate that all children with these symptoms should have a full eye examination to promote health and academic performance.
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11
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Fernández-Villa D, Asensio G, Silva M, Ramírez-Jiménez RA, Saldaña L, Vilaboa N, Leite-Oliveira A, San Román J, Vázquez-Lasa B, Rojo L. Vitamin B9 derivatives as carriers of bioactive cations for musculoskeletal regeneration applications: Synthesis, characterization and biological evaluation. Eur J Med Chem 2021; 212:113152. [PMID: 33453601 DOI: 10.1016/j.ejmech.2021.113152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 01/06/2023]
Abstract
The development of new drugs for musculoskeletal regeneration purposes has attracted much attention in the last decades. In this work, we present three novel vitamin B9 (folic acid)-derivatives bearing divalent cations (ZnFO, MgFO and MnFO), providing their synthesis mechanism and physicochemical characterization. In addition, a strong emphasis has been placed on evaluating their biological properties (along with our previously reported SrFO) using human mesenchymal stem cells (hMSC). In all the cases, pure folate derivatives (MFOs) with a bidentate coordination mode between the metal and the folate anion, and a 1:1 stoichiometry, were obtained in high yields. A non-cytotoxic dose of all the MFOs (50 μg/mL) was demonstrated to modulate by their own the mRNA profiles towards osteogenic-like or fibrocartilaginous-like phenotypes in basal conditions. Moreover, ZnFO increased the alkaline phosphatase activity in basal conditions, while both ZnFO and MnFO increased the matrix mineralization degree in osteoinductive conditions. Thus, we have demonstrated the bioactivity of these novel compounds and the suitability to further studied them in vivo for musculoskeletal regeneration applications.
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Affiliation(s)
- Daniel Fernández-Villa
- Instituto de Ciencia y Tecnología de Polímeros, Consejo Superior de Investigaciones Científicas (ICTP-CSIC), 28006, Madrid, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029, Madrid, Spain
| | - Gerardo Asensio
- Instituto de Ciencia y Tecnología de Polímeros, Consejo Superior de Investigaciones Científicas (ICTP-CSIC), 28006, Madrid, Spain
| | - Manuel Silva
- Universidade Católica Portuguesa - Centro de Biotecnologia e Química Fina, Escola Superior de Biotecnologia, 4169-005, Porto, Portugal
| | - Rosa Ana Ramírez-Jiménez
- Instituto de Ciencia y Tecnología de Polímeros, Consejo Superior de Investigaciones Científicas (ICTP-CSIC), 28006, Madrid, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029, Madrid, Spain
| | - Laura Saldaña
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029, Madrid, Spain; Hospital Universitario La Paz-IdiPAZ, 28029, Madrid, Spain
| | - Nuria Vilaboa
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029, Madrid, Spain; Hospital Universitario La Paz-IdiPAZ, 28029, Madrid, Spain
| | - Ana Leite-Oliveira
- Universidade Católica Portuguesa - Centro de Biotecnologia e Química Fina, Escola Superior de Biotecnologia, 4169-005, Porto, Portugal
| | - Julio San Román
- Instituto de Ciencia y Tecnología de Polímeros, Consejo Superior de Investigaciones Científicas (ICTP-CSIC), 28006, Madrid, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029, Madrid, Spain
| | - Blanca Vázquez-Lasa
- Instituto de Ciencia y Tecnología de Polímeros, Consejo Superior de Investigaciones Científicas (ICTP-CSIC), 28006, Madrid, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029, Madrid, Spain
| | - Luis Rojo
- Instituto de Ciencia y Tecnología de Polímeros, Consejo Superior de Investigaciones Científicas (ICTP-CSIC), 28006, Madrid, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029, Madrid, Spain.
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12
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Buchbinder R, Bourne A, Latimer J, Harris I, Whittle SL, Richards B, Taylor WJ, Clavisi O, Green S, Hinman RS, March L, Day R, Ferreira ML, Billot L, Maher CG. Early development of the Australia and New Zealand Musculoskeletal Clinical Trials Network. Intern Med J 2020; 50:17-23. [PMID: 30548385 DOI: 10.1111/imj.14191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/02/2018] [Indexed: 12/29/2022]
Abstract
The Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network was formed to build capacity and infrastructure for high-quality musculoskeletal clinical trials in our region. The purpose of this paper is to describe the steps taken in its formation to help others interested in establishing similar networks. In particular, we describe the steps taken to form the collaboration and our progress in achieving our vision and mission. Our aim is to focus on trials of highest importance and quality to provide definitive answers to the most pressing questions in our field.
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Affiliation(s)
- Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Allison Bourne
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Latimer
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
| | - Ian Harris
- Institute for Musculoskeletal Health, Sydney, New South Wales, Australia.,Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Samuel L Whittle
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, New South Wales, Australia.,The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Bethan Richards
- Institute for Musculoskeletal Health, Sydney, New South Wales, Australia.,Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - William J Taylor
- University of Otago, Wellington, New Zealand.,Hutt Valley District Health Board, Lower Hutt, New Zealand.,Tairawhiti District Health Board, Gisborne, New Zealand
| | | | - Sally Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lyn March
- University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Richard Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Laurent Billot
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Chris G Maher
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
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13
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Montpetit-Tourangeau K, Kairy D, Ahmed S, Anaby D, Bussières A, Lamontagne MÈ, Rochette A, Shikako-Thomas K, Thomas A. A strategic initiative to facilitate knowledge translation research in rehabilitation. BMC Health Serv Res 2020; 20:973. [PMID: 33097043 PMCID: PMC7585309 DOI: 10.1186/s12913-020-05772-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While there is a growing body of literature supporting clinical decision-making for rehabilitation professionals, suboptimal use of evidence-based practices in that field persists. A strategic initiative that ensures the relevance of the research and its implementation in the context of rehabilitation could 1) help improve the coordination of knowledge translation (KT) research and 2) enhance the delivery of evidence-based rehabilitation services offered to patients with physical disabilities. This paper describes the process and methods used to develop a KT strategic initiative aimed at building capacity and coordinating KT research in physical rehabilitation and its strategic plan; it also reports the initial applications of the strategic plan implementation. METHODS We used a 3-phase process consisting of an online environmental scan to identify the extent of KT research activities in physical rehabilitation in Quebec, Canada. Data from the environmental scan was used to develop a strategic plan that structures KT research in physical rehabilitation. Seven external KT experts in health science reviewed the strategic plan for consistency and applicability. RESULTS Sixty-four KT researchers were identified and classified according to the extent of their level of involvement in KT. Ninety-six research projects meeting eligibility criteria were funded by eight of the fourteen agencies and organizations searched. To address the identified gaps, a 5-year strategic plan was developed, containing a mission, a vision, four main goals, nine strategies and forty-two actions. CONCLUSION Such initiatives can help guide researchers and relevant key stakeholders, to structure, organize and advance KT research in the field of rehabilitation. The strategies are being implemented progressively to meet the strategic initiative's mission and ultimately enhance users' rehabilitation services.
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Affiliation(s)
- Katherine Montpetit-Tourangeau
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada. .,Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.
| | - Dahlia Kairy
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
| | - Sara Ahmed
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3654 Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec, H3A 1A2, Canada
| | - Dana Anaby
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3654 Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, 1400 Main Street West, Room 408, Hamilton, Ontario, L8S 1C7, Canada
| | - André Bussières
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3654 Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada.,Département Chiropratique, Université du Québec à Trois-Rivières, 3351, boul. Des Forges, C. P. 500, Trois-Rivières, Quebec, G9A 5H, Canada
| | - Marie-Ève Lamontagne
- Département de réadaptation, Université Laval, Quebec, Quebec, G1V 0A6, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de Réadaptation en Déficience Physique de Québec, 525 Boul Wilfrid-Hamel, Quebec, Quebec, G1M 2S8, Canada
| | - Annie Rochette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
| | - Keiko Shikako-Thomas
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3654 Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, 1400 Main Street West, Room 408, Hamilton, Ontario, L8S 1C7, Canada
| | - Aliki Thomas
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3654 Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada.,Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, 1110 Pine Avenue West, Montreal, Quebec, H3G 1A3, Canada
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14
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Walker P, De Morgan S, Sanders D, Nicholas M, Blyth FM. Primary care initiatives focused on the secondary prevention and management of chronic pain: a scoping review of the Australian literature. Aust J Prim Health 2020; 26:273-280. [PMID: 32669195 DOI: 10.1071/py20092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
The aim of this scoping review was to identify initiatives focused on the secondary prevention and management of chronic pain in Australian primary care to understand options available to Primary Health Networks and to identify evidence gaps. The Medline, EMBASE, Cumulative Index to Nursing and Allied Health Literature and Cochrane databases, as well as relevant websites, were searched for eligible records published from 2007 to 2018. Initiative characteristics and outcomes evaluated were extracted and synthesised. In all, 84 initiatives from 167 published and grey literature records were identified, including: (1) consumer initiatives that aimed to improve access to multidisciplinary care, health literacy and care navigation (n=56); (2) health professional capacity building initiatives that aimed to ensure health professionals are skilled and provide best-practice evidence-based care (n=21); and (3) quality improvement and health system support initiatives (n=7). Evidence gaps were found relating to initiatives addressing the secondary prevention of chronic pain, those targeting vulnerable and regional populations, health professional capacity building initiatives for all primary health care providers and quality improvement and system support initiatives. Addressing evidence gaps related to effectiveness, cost-effectiveness and implementation should be the focus for future chronic pain initiatives in primary care settings.
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Affiliation(s)
- Pippy Walker
- The Australian Prevention Partnership Centre and Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW 2006, Australia; and Corresponding author.
| | - Simone De Morgan
- The Australian Prevention Partnership Centre and Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW 2006, Australia
| | - Duncan Sanders
- Pain Management Research Institute, Sydney Medical School - Northern, Faculty of Medicine and Health, University of Sydney, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Michael Nicholas
- Pain Management Research Institute, Sydney Medical School - Northern, Faculty of Medicine and Health, University of Sydney, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Fiona M Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Edward Ford Building A27, Camperdown, NSW 2006, Australia
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15
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Bourne AM, Johnston RV, Cyril S, Briggs AM, Clavisi O, Duque G, Harris IA, Hill C, Hiller C, Kamper SJ, Latimer J, Lawson A, Lin CWC, Maher C, Perriman D, Richards BL, Smitham P, Taylor WJ, Whittle S, Buchbinder R. Scoping review of priority setting of research topics for musculoskeletal conditions. BMJ Open 2018; 8:e023962. [PMID: 30559158 PMCID: PMC6303563 DOI: 10.1136/bmjopen-2018-023962] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Describe research methods used in priority-setting exercises for musculoskeletal conditions and synthesise the priorities identified. DESIGN Scoping review. SETTING AND POPULATION Studies that elicited the research priorities of patients/consumers, clinicians, researchers, policy-makers and/or funders for any musculoskeletal condition were included. METHODS AND ANALYSIS We searched MEDLINE and EMBASE from inception to November 2017 and the James Lind Alliance top 10 priorities, Cochrane Priority Setting Methods Group, and Cochrane Musculoskeletal and Back Groups review priority lists. The reported methods and research topics/questions identified were extracted, and a descriptive synthesis conducted. RESULTS Forty-nine articles fulfilled our inclusion criteria. Methodologies and stakeholders varied widely (26 included a mix of clinicians, consumers and others, 16 included only clinicians, 6 included only consumers or patients and in 1 participants were unclear). Only two (4%) reported any explicit inclusion criteria for priorities. We identified 294 broad research priorities from 37 articles and 246 specific research questions from 17 articles, although only four (24%) of the latter listed questions in an actionable format. Research priorities for osteoarthritis were identified most often (n=7), followed by rheumatoid arthritis (n=4), osteoporosis (n=4) and back pain (n=4). Nearly half of both broad and specific research priorities were focused on treatment interventions (n=116 and 111, respectively), while few were economic (n=8, 2.7% broad and n=1, 0.4% specific), implementation (n=6, 2% broad and n=4, 1.6% specific) or health services and systems research (n=15, 5.1% broad and n=9, 3.7% specific) priorities. CONCLUSIONS While many research priority-setting studies in the musculoskeletal field have been performed, methodological limitations and lack of actionable research questions limit their usefulness. Future studies should ensure they conform to good priority-setting practice to ensure that the generated priorities are of maximum value. PROSPERO REGISTRATION NUMBER CRD42017059250.
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Affiliation(s)
- Allison M Bourne
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renea V Johnston
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sheila Cyril
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | | | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian A Harris
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Hill
- Division of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Rheumatology Unit, Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Department of Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Claire Hiller
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Steven J Kamper
- Centre for Pain, Health and Lifestyle, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jane Latimer
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Lawson
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | | | - Christopher Maher
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Diana Perriman
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Woden, Australian Capital Territory, Australia
- Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Bethan L Richards
- Rheumatology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Peter Smitham
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Sam Whittle
- Department of Rheumatology Unit, Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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16
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Jones IA, Togashi RC, Thomas Vangsness C. The Economics and Regulation of PRP in the Evolving Field of Orthopedic Biologics. Curr Rev Musculoskelet Med 2018; 11:558-565. [PMID: 30116992 PMCID: PMC6220002 DOI: 10.1007/s12178-018-9514-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review provides an update on the current status of platelet-rich plasma (PRP). Topics covered include the current regulatory environment, economic outlook, and current clinical evidence. RECENT FINDINGS The global PRP market is expected to grow to between 380 million and 4.5 billion (USD) over the next 5-10 years. The cost of a single treatment, which is not covered by most insurance, is roughly $500-$2500, with patients often returning for additional treatments. While PRP is not 'FDA-approved', it can be legally offered in the clinic 'off-label' in the USA for a myriad of musculoskeletal indications. Recently published meta-analyses have demonstrated statistically significant improvements that, in some cases, suggest that PRP may have clinically meaningful effects. However, given the fact that clearance is not synonymous with approval, PRP is a costly treatment not covered by insurance, and clinical trials have not demonstrated definitive efficacy, we recommend informing patients when providing PRP 'off-label'.
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Affiliation(s)
- Ian A Jones
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, HCT 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033, USA
| | - Ryan C Togashi
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, HCT 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033, USA
| | - C Thomas Vangsness
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, HCT 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033, USA.
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Rojo L. Combination of Polymeric Supports and Drug Delivery Systems for Osteochondral Regeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1059:301-313. [DOI: 10.1007/978-3-319-76735-2_13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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18
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Storberget M, Grødahl LHJ, Snodgrass S, van Vliet P, Heneghan N. Verbal augmented feedback in the rehabilitation of lower extremity musculoskeletal dysfunctions: a systematic review. BMJ Open Sport Exerc Med 2017; 3:e000256. [PMID: 29018544 PMCID: PMC5623330 DOI: 10.1136/bmjsem-2017-000256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background Verbal augmented feedback (VAF) is commonly used in physiotherapy rehabilitation of individuals with lower extremity musculoskeletal dysfunction or to induce motor learning for injury prevention. Its effectiveness for acquisition, retention and transfer of learning of new skills in this population is unknown. Objectives First, to investigate the effect of VAF for rehabilitation and prevention of lower extremity musculoskeletal dysfunction. Second, to determine its effect on motor learning and the stages of acquisition, retention and transfer in this population. Design Systematic review designed in accordance with the Centre for Reviews and Dissemination and reported in line with Preferred Reporting Items for Systematic Review and Meta-analysis. Method MEDLINE, Embase, PubMed and five additional databases were searched to identify primary studies with a focus on VAF for prevention and rehabilitation of lower extremity musculoskeletal dysfunction. One reviewer screened the titles and abstracts. Two reviewers retrieved full text articles for final inclusion. The first reviewer extracted data, whereas the second reviewer audited. Two reviewers independently assessed risk of bias and quality of evidence using Cochrane Collaboration’s tool and Grading of Recommendations Assessment, Development and Evaluation, respectively. Results Six studies were included, with a total sample of 304 participants. Participants included patients with lateral ankle sprain (n=76), postoperative ACL reconstruction (n=16) and healthy individuals in injury prevention (n=212). All six studies included acquisition, whereas retention was found in five studies. Only one study examined transfer of the achieved motor learning (n=36). VAF was found to be effective for improving lower extremity biomechanics and postural control with moderate evidence from five studies. Conclusion VAF should be considered in the rehabilitation of lower extremity musculoskeletal dysfunctions. However, it cannot be unequivocally confirmed that VAF is effective in this population, owing to study heterogeneity and a lack of high-quality evidence. Nevertheless, positive effects on lower extremity biomechanics and postural control have been identified. This suggests that further research into this topic is warranted where an investigation of long-term effects of interventions is required. All stages (acquisition, retention and transfer) should be evaluated.
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Affiliation(s)
- Marianne Storberget
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Linn Helen J Grødahl
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Suzanne Snodgrass
- School of Health Sciences (Physiotherapy), University of Newcastle, Callaghan, New South Wales, Australia
| | - Paulette van Vliet
- School of Health Sciences (Physiotherapy), University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicola Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Hodder RK, Wolfenden L, Kamper SJ, Lee H, Williams A, O'Brien KM, Williams CM. Developing implementation science to improve the translation of research to address low back pain: A critical review. Best Pract Res Clin Rheumatol 2017; 30:1050-1073. [PMID: 29103549 DOI: 10.1016/j.berh.2017.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/06/2017] [Accepted: 05/31/2017] [Indexed: 12/21/2022]
Abstract
The evidence base regarding treatment for back pain does not align with clinical practice. Currently there is relatively little evidence to guide health decision-makers on how to improve the use, uptake or adoption of evidence-based recommended practice for low back pain. Improving the design, conduct and reporting of strategies to improve the implementation of back pain care will help address this important evidence-practice gap. In this paper, we.
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Affiliation(s)
- Rebecca Kate Hodder
- School of Medicine and Public Health, The University of Newcastle, Australia; Hunter New England Population Health, Australia; Hunter Medical Research Institute, Australia; Centre for Pain, Health and Lifestyle, Australia.
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Australia; Hunter New England Population Health, Australia; Hunter Medical Research Institute, Australia
| | - Steven J Kamper
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Pain, Health and Lifestyle, Australia
| | - Hopin Lee
- School of Medicine and Public Health, The University of Newcastle, Australia; Hunter Medical Research Institute, Australia; Centre for Pain, Health and Lifestyle, Australia; Centre for Rehabilitation Research, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Amanda Williams
- School of Medicine and Public Health, The University of Newcastle, Australia; Hunter New England Population Health, Australia; Hunter Medical Research Institute, Australia; Centre for Pain, Health and Lifestyle, Australia
| | - Kate M O'Brien
- School of Medicine and Public Health, The University of Newcastle, Australia; Hunter New England Population Health, Australia; Hunter Medical Research Institute, Australia; Centre for Pain, Health and Lifestyle, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, The University of Newcastle, Australia; Hunter New England Population Health, Australia; Hunter Medical Research Institute, Australia; Centre for Pain, Health and Lifestyle, Australia
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Tunnicliffe DJ, Singh-Grewal D, Craig JC, Howell M, Tugwell P, Mackie F, Lin MW, O'Neill SG, Ralph AF, Tong A. Healthcare and Research Priorities of Adolescents and Young Adults with Systemic Lupus Erythematosus: A Mixed-methods Study. J Rheumatol 2017; 44:444-451. [PMID: 28250139 DOI: 10.3899/jrheum.160720] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Managing juvenile-onset systemic lupus erythematosus (SLE) is particularly challenging. The disease may be severe, adolescent patients have complex medical and psychosocial needs, and patients must navigate the transition to adult services. To inform patient-centered care, we aimed to identify the healthcare and research priorities of young patients with SLE and describe the reasons underpinning their priorities. METHODS Face-to-face, semistructured interviews and focus groups were conducted with patients with SLE, aged from 14 to 26 years, from 5 centers in Australia. For each of the 5 allocation exercises, participants allocated 10 votes to (1) research topics; research questions on (2) medical management, (3) prevention and diagnosis, (4) lifestyle and psychosocial; and (5) healthcare specialties, and discussed the reasons for their choices. Descriptive statistics were calculated for votes and qualitative data were analyzed thematically. RESULTS The 26 participants prioritized research that alleviated the psychological burden of SLE. They allocated their votes toward medical and mental health specialties in the management of SLE, while fewer votes were given to physiotherapy/occupational therapy and dietetics. The following 7 themes underpinned the participants' priorities: improving service shortfalls, strengthening well-being, ensuring cost efficiency, minimizing family/community burden, severity of comorbidity or complications, reducing lifestyle disruption, and fulfilling future goals. CONCLUSION Young patients with SLE value comprehensive care with greater coordination among specialties. They prioritized research focused on alleviating poor psychological outcomes. The healthcare and research agenda for patients with SLE should include everyone involved, to ensure that the agenda aligns with patient priorities, needs, and values.
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Affiliation(s)
- David J Tunnicliffe
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada. .,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead.
| | - Davinder Singh-Grewal
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Jonathan C Craig
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Martin Howell
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Peter Tugwell
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Fiona Mackie
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Ming-Wei Lin
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Sean G O'Neill
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Angelique F Ralph
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
| | - Allison Tong
- From the Sydney School of Public Health, and Sydney Medical School, The University of Sydney; Centre for Kidney Research, The Children's Hospital at Westmead; Department of Rheumatology, The Sydney Children's Hospital Network; Faculty of Medicine, and School of Women's and Children's Health, The University of New South Wales; Department of Nephrology, Sydney Children's Hospital Randwick; Department of Immunology, Westmead Hospital; Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, Sydney, Australia; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada.,D.J. Tunnicliffe, PhD candidate, MIPH, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; D. Singh-Grewal, PhD, Clinical Senior Lecturer, Pediatric Rheumatologist, Sydney Medical School, The University of Sydney, and Department of Rheumatology, The Sydney Children's Hospital Network, and Faculty of Medicine, The University of New South Wales; J.C. Craig, PhD, Professor of Clinical Epidemiology, Pediatric Nephrologist, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; M. Howell, PhD, Research Associate, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; P. Tugwell, MD, Director, Centre for Global Health, University of Ottawa; F. Mackie, PhD, Conjoint Senior Lecturer, Pediatric Nephrologist, School of Women's and Children's Health, The University of New South Wales, and Department of Nephrology, Sydney Children's Hospital Randwick; M.W. Lin, MBBS, Clinical lecturer, Immunologist, Sydney Medical School, The University of Sydney, and Department of Immunology, Westmead Hospital; S.G. O'Neill, PhD, FRACP, Rheumatologist, Department of Rheumatology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research; A.F. Ralph, PhD Candidate, BPsych(Hons), Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead; A. Tong, PhD, National Health Medical Research Council Career Development Fellow, Sydney School of Public Health, The University of Sydney, and the Centre for Kidney Research, The Children's Hospital at Westmead
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Abstract
Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Management guidelines endorse triage to identify the rare cases of low back pain that are caused by medically serious pathology, and so require diagnostic work-up or specialist referral, or both. Because non-specific low back pain does not have a known pathoanatomical cause, treatment focuses on reducing pain and its consequences. Management consists of education and reassurance, analgesic medicines, non-pharmacological therapies, and timely review. The clinical course of low back pain is often favourable, thus many patients require little if any formal medical care. Two treatment strategies are currently used, a stepped approach beginning with more simple care that is progressed if the patient does not respond, and the use of simple risk prediction methods to individualise the amount and type of care provided. The overuse of imaging, opioids, and surgery remains a widespread problem.
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Affiliation(s)
- Chris Maher
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Monash Department of Clinical Epidemiology, Cabrini Hospital, Monash University, Melbourne, VIC, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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22
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Mahmood S, Lesuis N, van Tuyl LHD, van Riel P, Landewé R. Quality in rheumatoid arthritis care. Best Pract Res Clin Rheumatol 2015; 29:664-79. [PMID: 26697773 DOI: 10.1016/j.berh.2015.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 11/17/2022]
Abstract
While most rheumatology practices are characterized by strong commitment to quality of care and continuous improvement to limit disability and optimize quality of life for patients and their families, the actual step toward improvement is often difficult. This is because there are still barriers to be addressed and facilitators to be captured before a satisfying and cost-effective practice management is installed. Therefore, this review aims to assist practicing rheumatologists with quality improvement of their daily practice, focusing on care for rheumatoid arthritis (RA) patients. First we define quality of care as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge". Often quality is determined by the interplay between structure, processes, and outcomes of care, which is also reflected in the corresponding indicators to measure quality of care. Next, a brief overview is given of the current treatment strategies used in RA, focusing on the tight control strategy, since this strategy forms the basis of international treatment guidelines. Adherence to tight control strategies leads, also in daily practice, to better outcomes in patients with regard to disease control, functional status, and work productivity. Despite evidence in favor of tight control strategies, adherence in daily practice is often challenging. Therefore, the next part of the review focuses on possible barriers and facilitators of adherence, and potential interventions to improve quality of care. Many different barriers and facilitators are known and targeting these can be effective in changing care, but these effects are rather small to moderate. With regard to RA, few studies have tried to improve care, such as a study aiming to increase the number of disease activity measures done by a combination of education and feedback. Two out of the three studies showed markedly positive effects of their interventions, suggesting that change is possible. Finally, a simple step-by-step plan is described, which could be used by rheumatologists in daily practice wanting to improve their RA patient care.
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Affiliation(s)
- Sehrash Mahmood
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Department of Rheumatology, Room ZH 3A-58, De boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| | - Nienke Lesuis
- Sint Maartenskliniek, Department of Rheumatology, Hengstdal 3, 6500, GM, Nijmegen, The Netherlands.
| | - Lilian H D van Tuyl
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Department of Rheumatology, Room ZH 3A-56, De boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| | - Piet van Riel
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Robert Landewé
- Amsterdam Rheumatology and Immunology Center, Academic Medical Center, Meibergdreef 9, The Netherlands.
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