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Kendrick D, Lindley R, Blackburn L, Roadevin C, Thompson E, Andrews I, Anwar F, Brooks A, Carlton E, Crouch R, Day F, Fallon S, Farrin A, Graham L, Hoffman K, Howell R, Holmes J, James M, Jones T, Kellezi B, Kettlewell J, Morriss R, das Nair R, Richardson D, Smith M, Timmons S, Wright-Hughes A, Radford K. Early vocational rehabilitation and psychological support for trauma patients to improve return to work (the ROWTATE trial): study protocol for an individually randomised controlled multicentre pragmatic trial. Trials 2024; 25:439. [PMID: 38956682 PMCID: PMC11221047 DOI: 10.1186/s13063-024-08183-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 05/17/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Moderately severe or major trauma (injury severity score (ISS) > 8) is common, often resulting in physical and psychological problems and leading to difficulties in returning to work. Vocational rehabilitation (VR) can improve return to work/education in some injuries (e.g. traumatic brain and spinal cord injury), but evidence is lacking for other moderately severe or major trauma. METHODS ROWTATE is an individually randomised controlled multicentre pragmatic trial of early VR and psychological support in trauma patients. It includes an internal pilot, economic evaluation, a process evaluation and an implementation study. Participants will be screened for eligibility and recruited within 12 weeks of admission to eight major trauma centres in England. A total of 722 participants with ISS > 8 will be randomised 1:1 to VR and psychological support (where needed, following psychological screening) plus usual care or to usual care alone. The ROWTATE VR intervention will be provided within 2 weeks of study recruitment by occupational therapists and where needed, by clinical psychologists. It will be individually tailored and provided for ≤ 12 months, dependent on participant need. Baseline assessment will collect data on demographics, injury details, work/education status, cognitive impairment, anxiety, depression, post-traumatic distress, disability, recovery expectations, financial stress and health-related quality of life. Participants will be followed up by postal/telephone/online questionnaires at 3, 6 and 12 months post-randomisation. The primary objective is to establish whether the ROWTATE VR intervention plus usual care is more effective than usual care alone for improving participants' self-reported return to work/education for at least 80% of pre-injury hours at 12 months post-randomisation. Secondary outcomes include other work outcomes (e.g. hours of work/education, time to return to work/education, sickness absence), depression, anxiety, post-traumatic distress, work self-efficacy, financial stress, purpose in life, health-related quality of life and healthcare/personal resource use. The process evaluation and implementation study will be described elsewhere. DISCUSSION This trial will provide robust evidence regarding a VR intervention for a major trauma population. Evidence of a clinically and cost-effective VR intervention will be important for commissioners and providers to enable adoption of VR services for this large and important group of patients within the NHS. TRIAL REGISTRATION ISRCTN: 43115471. Registered 27/07/2021.
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Affiliation(s)
- Denise Kendrick
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK.
| | - Rebecca Lindley
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Lauren Blackburn
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Cristina Roadevin
- Nottingham Clinical Trials Unit, University Park, Nottingham, NG7 2RD, UK
| | - Ellen Thompson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Isabel Andrews
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Fahim Anwar
- Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Adam Brooks
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Edd Carlton
- North Bristol NHS Trust Southmead Hospital, Southmead Road, Westbury-On-Trym, Bristol, BS10 5NB, UK
| | - Robert Crouch
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, S016 6YD, UK
| | - Florence Day
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Steve Fallon
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Amanda Farrin
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Laura Graham
- Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK
| | - Karen Hoffman
- Centre for Trauma Sciences, Barts Health NHS Trust and Queen Mary University London, Blizard Institute, 4 Newark St, London, E1 2AT, UK
| | - Rebekah Howell
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jain Holmes
- Centre for Rehabilitation & Ageing Research (CRAR), Injury, Recovery Sciences and Inflammation (IRIS), School of Medicine, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Marilyn James
- Nottingham Clinical Trials Unit, University Park, Nottingham, NG7 2RD, UK
| | - Trevor Jones
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Blerina Kellezi
- Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
| | - Jade Kettlewell
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Richard Morriss
- Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | | | - Davina Richardson
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK
| | - Matthew Smith
- Academic Department of Rehabilitation Medicine, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Stephen Timmons
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, NG8 1BB, UK
| | | | - Kathryn Radford
- Centre for Rehabilitation & Ageing Research (CRAR), Injury, Recovery Sciences and Inflammation (IRIS), School of Medicine, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
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Geerts M, Hoeijmakers JG, van Eijk-Hustings Y, Brandts L, Gorissen-Brouwers CM, Merkies IS, Joore MA, Faber CG. Cost of illness of patients with small fiber neuropathy in the Netherlands. Pain 2024; 165:153-163. [PMID: 37556388 PMCID: PMC10723644 DOI: 10.1097/j.pain.0000000000003008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 08/11/2023]
Abstract
ABSTRACT Neuropathic pain is associated with substantial healthcare costs. However, cost-of-illness studies of small fiber neuropathy (SFN) are scarce. Our aim was to estimate the healthcare, patient and family, and productivity costs of patients with SFN in the Netherlands from a healthcare and societal perspective. In addition, the association of costs with age, pain impact on daily life, anxiety, depression, and quality of life (Qol) were examined. Cost questionnaires were completed by 156 patients with confirmed SFN. The average annual total health care and societal cost (€, 2020) was calculated at patient, SFN adult population, and societal level. The average annual healthcare, patient and family, and productivity costs per patient with a Pain Impact Numerical Rating Scale of 0 to 3 (mild), 4 to 6 (moderate), and 7 to 10 (severe) were calculated by using the cost questionnaire data. Quality of life was determined by the EuroQol 5D utility scores. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Associations of all costs were analyzed using linear regression analyses. At the patient level, the average annual SFN healthcare and societal cost of SFN was €3614 (95% confidence interval [CI] €3171-€4072) and €17,871 (95% CI €14,395-€21,480). At the SFN population level, the average healthcare costs were €29.8 (CI €26.4-€34.2) million, and on a societal level, these were €147.7 (CI 120.5-176.3) million. Severe pain was associated with significant lower Qol and higher depression scores, higher healthcare, patient and family, and productivity costs ( P < 0.001).
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Affiliation(s)
- Margot Geerts
- Department of Neurology, Maastricht University Medical Center+, School of Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Janneke G.J. Hoeijmakers
- Department of Neurology, Maastricht University Medical Center+, School of Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Yvonne van Eijk-Hustings
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Lloyd Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Carla M.L. Gorissen-Brouwers
- Department of Neurology, Maastricht University Medical Center+, School of Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Ingemar S.J. Merkies
- Department of Neurology, Maastricht University Medical Center+, School of Mental Health and Neuroscience, Maastricht, the Netherlands
- Department of Neurology, Curacao Medical Center, J. H. J. Hamelbergweg, Willemstad, Curacao
| | - Manuela A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Catharina G. Faber
- Department of Neurology, Maastricht University Medical Center+, School of Mental Health and Neuroscience, Maastricht, the Netherlands
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Torres L, Caciula MC, Tomoiaga AS, Gugu-Gramatopol C. Correlations between Mental Health, Physical Activity, and Body Composition in American College Students after the COVID-19 Pandemic Lockdown. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7045. [PMID: 37998276 PMCID: PMC10670983 DOI: 10.3390/ijerph20227045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023]
Abstract
Restrictions associated with the COVID-19 pandemic had forced American college students to significantly reduce their daily energy expenditure and increase their sedentary behaviors, thus presumably increasing mental health symptoms, decreasing physical activity levels, and enhancing the promotion of unhealthy eating habits. This study aimed to explore the correlations between mental health symptoms, physical activity levels, and body composition in college students in the years following the pandemic, focusing on the lingering effects of lockdown measures. American college students completed pre-existing, well-validated surveys for both mental health (Hospital Anxiety and Depression Scale) and physical activity (International Physical Activity Questionnaire-Long Form). Body composition was assessed in person with the use of an Inbody 570 device. Of the 90 American college students (M age = 22.52 ± 4.54, 50 females) who participated in this study, depressive and anxious symptom scores consistent with heightened symptomatology were reported by 58% of the participants (N = 52), moderate borderline symptomatology by 17% (N = 15), and asymptomatology by 25% (N = 23). In regard to physical activity, 79% (N = 71) of the students were highly physically active, 18% (N = 16) were moderately active, and 3% (N = 3) reported low levels of physical activity. Additionally, 46% (N = 41) of the students maintained an unhealthy body fat percentage based on the World Health Organization recommendations. Strong, significant relationships were found between anxiety and depression symptomatology and body fat percentage (positive correlation, p = 0.003) and between anxiety and depression symptomatology and skeletal muscle mass (negative correlation, p = 0.015), with said symptomatology increasing with added body fat and decreasing with added skeletal muscle mass. The COVID-19 pandemic lockdown restrictions affected American college students through an increase in mental health symptomatology and a deterioration in overall body composition.
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Affiliation(s)
- Luis Torres
- Department of Exercise Science and Physical Education, Montclair State University, Montclair, NJ 07043, USA
| | - Manuela C. Caciula
- Department of Health and Exercise Science, New Jersey City University, Jersey City, NJ 07305, USA;
| | - Alin S. Tomoiaga
- Department of Accounting, Business, Analytics, CIS, and Law, Manhattan College, Bronx, NY 10471, USA;
| | - Carmen Gugu-Gramatopol
- Department of Physical Education and Mountain Sports, Transilvania University of Brasov, 500036 Brasov, Romania;
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Sabater-Martos M, Martínez-Pastor JC, Morales A, Ferrer M, Antequera A, Roqué M. [Translated article] Overview of systematic reviews of risk factors for prosthetic joint infection. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T426-T445. [PMID: 37364724 DOI: 10.1016/j.recot.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SRs) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SRs are increasingly frequent, their methodological field presents some knowledge gaps. PURPOSE To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. MATERIAL AND METHODS We conducted a bibliographic search in 4 databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. RESULTS Twenty-three SRs were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8 SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. CONCLUSIONS Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SRs are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.
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Affiliation(s)
- M Sabater-Martos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - J C Martínez-Pastor
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Morales
- Fisioterapia Vestibular, Rehabilitación del Vértigo y el Equilibrio, Fisioterapia del Aparato Locomotor, Barcelona, Spain
| | - M Ferrer
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Antequera
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - M Roqué
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
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Skrifvars MB, Luethi N, Bailey M, French C, Nichol A, Trapani T, McArthur C, Arabi YM, Bendel S, Cooper DJ, Bellomo R. The effect of recombinant erythropoietin on long-term outcome after moderate-to-severe traumatic brain injury. Intensive Care Med 2023; 49:831-839. [PMID: 37405413 PMCID: PMC10353955 DOI: 10.1007/s00134-023-07141-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE Recombinant erythropoietin (EPO) administered for traumatic brain injury (TBI) may increase short-term survival, but the long-term effect is unknown. METHODS We conducted a pre-planned long-term follow-up of patients in the multicentre erythropoietin in TBI trial (2010-2015). We invited survivors to follow-up and evaluated survival and functional outcome with the Glasgow Outcome Scale-Extended (GOSE) (categories 5-8 = good outcome), and secondly, with good outcome determined relative to baseline function (sliding scale). We used survival analysis to assess time to death and absolute risk differences (ARD) to assess favorable outcomes. We categorized TBI severity with the International Mission for Prognosis and Analysis of Clinical Trials in TBI model. Heterogeneity of treatment effects were assessed with interaction p-values based on the following a priori defined subgroups, the severity of TBI, and the presence of an intracranial mass lesion and multi-trauma in addition to TBI. RESULTS Of 603 patients in the original trial, 487 patients had survival data; 356 were included in the follow-up at a median of 6 years from injury. There was no difference between treatment groups for patient survival [EPO vs placebo hazard ratio (HR) (95% confidence interval (CI) 0.73 (0.47-1.14) p = 0.17]. Good outcome rates were 110/175 (63%) in the EPO group vs 100/181 (55%) in the placebo group (ARD 8%, 95% CI [Formula: see text] 3 to 18%, p = 0.14). When good outcome was determined relative to baseline risk, the EPO groups had better GOSE (sliding scale ARD 12%, 95% CI 2-22%, p = 0.02). When considering long-term patient survival, there was no evidence for heterogeneity of treatment effect (HTE) according to severity of TBI (p = 0.85), presence of an intracranial mass lesion (p = 0.48), or whether the patient had multi-trauma in addition to TBI (p = 0.08). Similarly, no evidence of treatment heterogeneity was seen for the effect of EPO on functional outcome. CONCLUSION EPO neither decreased overall long-term mortality nor improved functional outcome in moderate or severe TBI patients treated in the intensive care unit (ICU). The limited sample size makes it difficult to make final conclusions about the use of EPO in TBI.
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Affiliation(s)
- Markus B Skrifvars
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, PB 340, 00029 HUS, Helsinki, Finland.
| | - Nora Luethi
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, VIC, Australia
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Colin McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Yaseen M Arabi
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern, Kuopio, Finland
| | - David J Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
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Kellezi B, Dhiman P, Coupland C, Whitehead J, Morriss R, Joseph S, Beckett K, Sleney J, Barnes J, Kendrick D. Mental health and other factors associated with work productivity after injury in the UK: multicentre cohort study. Inj Prev 2021; 28:131-140. [PMID: 34462332 DOI: 10.1136/injuryprev-2021-044311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/31/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Mental health conditions are a major contributor to productivity loss and are common after injury. This study quantifies postinjury productivity loss and its association with preinjury and postinjury mental health, injury, demographic, health, social and other factors. METHODS Multicentre, longitudinal study recruiting hospitalised employed individuals aged 16-69 years with unintentional injuries, followed up at 1, 2, 4 and 12 months. Participants completed questionnaires on injury, demographic factors, health (including mental health), social factors, other factors and on-the-job productivity upon return to work (RTW). ORs were estimated for above median productivity loss using random effects logistic regression. RESULTS 217 adults had made an RTW at 2, 4 or 12 months after injury: 29% at 2 months, 66% at 4 months and 83% at 12 months. Productivity loss reduced over time: 3.3% of working time at 2 months, 1.7% at 4 months, 1% at 12 months. Significantly higher productivity loss was associated with preinjury psychiatric conditions (OR 21.40, 95% CI 3.50 to 130.78) and post-traumatic stress avoidance symptoms at 1 month (OR for 1-unit increase in score 1.15, 95% CI 1.07 to 1.22). Significantly lower productivity loss was associated with male gender (OR 0.32, 95% CI 0.14 to 0.74), upper and lower limb injuries (vs other body regions, OR 0.15, 95% CI 0.03 to 0.81) and sports injuries (vs home, OR 0.18, 95% CI 0.04 to 0.78). Preinjury psychiatric conditions and gender remained significant in analysis of multiply imputed data. CONCLUSIONS Unintentional injury results in substantial productivity loss. Females, those with preinjury psychiatric conditions and those with post-traumatic stress avoidance symptoms experience greater productivity loss and may require additional support to enable successful RTW.
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Affiliation(s)
- Blerina Kellezi
- Department of Psychology, Nottingham Trent University, Nottingham, UK .,Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Paula Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,School of Medicine, Research Design Service East Midlands (RDS EM), Queen's Medical Centre, Nottingham, UK
| | - Carol Coupland
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Joanne Whitehead
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Richard Morriss
- Faculty of Medicine and Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Stephen Joseph
- School of Education, University of Nottingham, Nottingham, UK
| | | | - Jude Sleney
- Department of Sociology, University of Surrey, Guildford, UK
| | - Jo Barnes
- Loughborough Design School, Loughborough University, Loughborough, UK
| | - Denise Kendrick
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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