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Haroutounian S, Holzer KJ, Kerns RD, Veasley C, Dworkin RH, Turk DC, Carman KL, Chambers CT, Cowan P, Edwards RR, Eisenach JC, Farrar JT, Ferguson M, Forsythe LP, Freeman R, Gewandter JS, Gilron I, Goertz C, Grol-Prokopczyk H, Iyengar S, Jordan I, Kamp C, Kleykamp BA, Knowles RL, Langford DJ, Mackey S, Malamut R, Markman J, Martin KR, McNicol E, Patel KV, Rice AS, Rowbotham M, Sandbrink F, Simon LS, Steiner DJ, Vollert J. Patient engagement in designing, conducting, and disseminating clinical pain research: IMMPACT recommended considerations. Pain 2024; 165:1013-1028. [PMID: 38198239 PMCID: PMC11017749 DOI: 10.1097/j.pain.0000000000003121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 01/12/2024]
Abstract
ABSTRACT In the traditional clinical research model, patients are typically involved only as participants. However, there has been a shift in recent years highlighting the value and contributions that patients bring as members of the research team, across the clinical research lifecycle. It is becoming increasingly evident that to develop research that is both meaningful to people who have the targeted condition and is feasible, there are important benefits of involving patients in the planning, conduct, and dissemination of research from its earliest stages. In fact, research funders and regulatory agencies are now explicitly encouraging, and sometimes requiring, that patients are engaged as partners in research. Although this approach has become commonplace in some fields of clinical research, it remains the exception in clinical pain research. As such, the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials convened a meeting with patient partners and international representatives from academia, patient advocacy groups, government regulatory agencies, research funding organizations, academic journals, and the biopharmaceutical industry to develop consensus recommendations for advancing patient engagement in all stages of clinical pain research in an effective and purposeful manner. This article summarizes the results of this meeting and offers considerations for meaningful and authentic engagement of patient partners in clinical pain research, including recommendations for representation, timing, continuous engagement, measurement, reporting, and research dissemination.
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Affiliation(s)
- Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Katherine J. Holzer
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Robert D. Kerns
- Departments of Psychiatry, Neurology, and Psychology, Yale University, New Haven, CT, United States
| | - Christin Veasley
- Chronic Pain Research Alliance, North Kingstown, RI, United States
| | - Robert H. Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Dennis C. Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
| | - Kristin L. Carman
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, United States
| | - Christine T. Chambers
- Departments of Psychology & Neuroscience and Pediatrics, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, CA, United States
| | - Robert R. Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
| | - James C. Eisenach
- Departments of Anesthesiology, Physiology and Pharmacology, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - John T. Farrar
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - McKenzie Ferguson
- Southern Illinois University Edwardsville, School of Pharmacy, Edwardsville, IL, United States
| | - Laura P. Forsythe
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, United States
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jennifer S. Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Christine Goertz
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
| | | | - Smriti Iyengar
- Division of Translational Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Isabel Jordan
- Departments of Psychology & Neuroscience and Pediatrics, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Cornelia Kamp
- Center for Health and Technology/Clinical Materials Services Unit, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Bethea A. Kleykamp
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Rachel L. Knowles
- Medical Research Council (part of UK Research and Innovation), London, United Kingdom
| | - Dale J. Langford
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, United States
| | - Sean Mackey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, Stanford, CA, United States
| | | | - John Markman
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Kathryn R. Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Ewan McNicol
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA, United States
| | - Kushang V. Patel
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
| | - Andrew S.C. Rice
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Michael Rowbotham
- Departments of Anesthesia and Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Friedhelm Sandbrink
- National Pain Management, Opioid Safety, and Prescription Drug Monitoring Program, Specialty Care Program Office, Veterans Health Administration, Washington, DC, United States
| | | | - Deborah J. Steiner
- Global Pain, Pain & Neurodegeneration, Eli Lilly and Company, Indianapolis, IN, United States
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Ruprecht Karls University, Heidelberg, Germany
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Bejarano G, Vining R, Desai DP, Minchew J, Michael Guo H, Goertz C. Development of a low back pain care pathway in an academic hospital system: results of a consensus process. J Orthop Surg Res 2024; 19:11. [PMID: 38169412 PMCID: PMC10763186 DOI: 10.1186/s13018-023-04492-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is the leading cause of disability worldwide and a significant component of healthcare expenditures. Clinical practice guidelines (CPGs) have been highlighted as a key resource to improve the quality of care. This study aimed to develop a clinical pathway for LBP based on CPGs in an academic health system. METHODS We conducted a modified Delphi study of clinicians caring for patients with LBP who were asked to rate 21 CPG-informed seed statements through an online survey. The goal was to identify statements that achieved a minimum of 80% consensus among panelists. RESULTS Thirty-five healthcare providers participated as panelists. The majority of participants were male (68.6%), had MD or DO (62.9%) degrees, and were clinicians (73.8%) working in neurosurgery (36.1%), orthopedics (25.7%), emergency medicine (14.3%), or physical therapy (11.4%). Initially, consensus was reached on 20 of 21 seed statements. One statement did not reach consensus in the initial round and was revised into two separate statements based on feedback from panelists. One of these statements achieved consensus in the second review round. All statements reaching consensus were incorporated into a care pathway consisting of diagnosis, evaluation, and treatment for LBP. CONCLUSION Healthcare providers across various disciplines supported statements interpreting current CPGs related to care for LBP. This study represents a step toward supporting guideline-concordant care for LBP. Additional research is needed to assess how such pathways impact actual clinical care.
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Affiliation(s)
| | | | - Devan P Desai
- Duke University, 300 W. Morgan Street, Office 441, Durham, NC, 27701, USA
| | - Joe Minchew
- Duke University, 300 W. Morgan Street, Office 441, Durham, NC, 27701, USA
| | - H Michael Guo
- Duke University, 300 W. Morgan Street, Office 441, Durham, NC, 27701, USA
| | - Christine Goertz
- Duke University, 300 W. Morgan Street, Office 441, Durham, NC, 27701, USA.
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Johnson CD, Green BN, Agaoglu M, Amorin-Woods L, Brown R, Byfield D, Clum GW, Crespo W, Da Silva KL, Dane D, Daniels CJ, Edwards M, Foshee WK, Goertz C, Henderson C, Hynes R, Johnson V, Killinger L, Konarski-Hart K, Kopansky-Giles D, Kowalski M, Little C, McAllister S, Mrozek J, Nixdorf D, Peeace LD, Peterson C, Petrocco-Napuli KL, Phillips R, Snow G, Sorrentino A, Wong YK, Yelverton C, Young KJ. Chiropractic Day 2023: A Report and Qualitative Analysis of How Thought Leaders Celebrate the Present and Envision the Future of Chiropractic. J Chiropr Humanit 2023; 30:23-45. [PMID: 37841068 PMCID: PMC10569958 DOI: 10.1016/j.echu.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 10/17/2023]
Abstract
Objective This study aimed to (1) collect and analyze statements about how to celebrate chiropractic in the present and roles that chiropractors may fulfill in the future, (2) identify if there was congruence among the themes between present and future statements, and (3) offer a model about the chiropractic profession that captures its complex relationships that encompass its interactions within microsystem, mesosystem, exosystem, and macrosystem levels. Methods For this qualitative analysis, we used pattern and grounded theory approaches. A purposive sample of thought leaders in the chiropractic profession were invited to answer the following 2 open-ended questions: (1) envision the chiropractor of the future, and (2) recommendations on how to celebrate chiropractic. Information was collected during April 2023 using Survey Monkey. The information was entered into a spreadsheet and analyzed for topic clusters, which resulted in matching concepts with social-ecological themes. The themes between the responses to the 2 questions were analyzed for congruence. We used the Standards for Reporting Qualitative Research to report our findings. Results Of the 54 experts invited, 32 (59%) participated. Authors represented 7 countries and have a median of 32 years of chiropractic experience, with a range of 5 to 51 years. Nineteen major topics in the future statements and 23 major topics in statements about celebrating chiropractic were combined in a model. The topics were presented using the 4 levels of the social-ecological framework. Individual (microsystem): chiropractors are competent, well-educated experts in spine and musculoskeletal care who apply evidence-based practices, which is a combination of the best available evidence, clinical expertise, and patient values. Interpersonal relationships (mesosystem): chiropractors serve the best interests of their patients, provide person-centered care, embrace diversity, equity, and inclusion, consider specific health needs and the health of the whole person. Community (exosystem): chiropractors provide care within integrated health care environments and in private practices, serve the best interests of the public through participation in their communities, participate through multidisciplinary collaboration with and within the health care system, and work together as a profession with a strong professional identity. Societal (macrosystem): chiropractors contribute to the greater good of society and participate on a global level in policy, leadership, and research. There was concordance between both the future envisioning statements and the present celebration recommendations, which suggest logical validity based on the congruence of these concepts. Conclusion A sample of independent views, including the perceptions from a broad range of chiropractic thought leaders from various backgrounds, philosophies, diversity characteristics, and world regions, were assembled to create a comprehensive model of the chiropractic profession. The resulting model shows an array of intrinsic values and provides the roles that chiropractors may provide to serve patients and the public. This study offers insights into the roles that future chiropractors may fulfill and how these are congruent with present-day values. These core concepts and this novel model may have utility during dialogs about identity, applications regarding chiropractic in policy, practice, education, and research, and building positive relationships and collaborations.
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Affiliation(s)
| | - Bart N. Green
- National University of Health Sciences, Lombard, Illinois
| | - Mustafa Agaoglu
- AECC University College, Bournemouth, United Kingdom
- Turkish Chiropractic Association, Turkey
| | - Lyndon Amorin-Woods
- College of Health & Education, School of Allied Health, Murdoch University, Perth, Australia
| | | | - David Byfield
- Welsh Institute of Chiropractic, University of South Wales, Pontypridd, United Kingdom
| | | | | | - Kendrah L. Da Silva
- Chiropractic Association of South Africa, Centurion, South Africa
- University of Johannesburg, Johannesburg, South Africa
| | - Dawn Dane
- Central Queensland University, Queensland, Australia
| | - Clinton J. Daniels
- Veterans Administration Puget Sound Health Care System, Tacoma, Washington
| | | | | | | | - Charles Henderson
- Henderson Technical Consulting and Life Chiropractic College West, Hayward, California
| | - Roger Hynes
- Palmer College of Chiropractic, Davenport, Iowa
| | - Valerie Johnson
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California
| | | | | | | | - Matthew Kowalski
- Osher Center for Integrative Medicine at Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Craig Little
- Council on Chiropractic Education, Scottsdale, Arizona
| | | | | | | | | | - Cynthia Peterson
- European Council on Chiropractic Education and Councils on Chiropractic Education International, British Columbia, Canada
- University of Johannesburg, Johannesburg, South Africa
| | | | | | - Gregory Snow
- Palmer College of Chiropractic West, San Jose, California
| | | | - Yi Kai Wong
- Association of Chiropractic Malaysia, Kuala Lumpur, Malaysia
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4
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Lentz TA, Gonzalez-Smith J, Huber K, Goertz C, Bleser WK, Saunders R. Overcoming Barriers to the Implementation of Integrated Musculoskeletal Pain Management Programs: A Multi-Stakeholder Qualitative Study. J Pain 2023; 24:860-873. [PMID: 36634887 DOI: 10.1016/j.jpain.2022.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023]
Abstract
Integrated pain management (IPM) programs can help to reduce the substantial population health burden of musculoskeletal pain, but are poorly implemented. Lessons learned from existing programs can inform efforts to expand IPM implementation. This qualitative study describes how health care systems, payers, providers, health policy researchers, and other stakeholders are overcoming barriers to developing and sustaining IPM programs in real-world settings. Primary data were collected February 2020 through September 2021 from a multi-sector expert panel of 25 stakeholders, 53 expert interviews representing 30 distinct IPM programs across the United States, and 4 original case studies of exemplar IPM programs. We use a consensual team-based approach to systematically analyze qualitative findings. We identified 4 major themes around challenges and potential solutions for implementing IPM programs: navigating coverage, payment, and reimbursement; enacting organizational change; making a business case to stakeholders; and overcoming regulatory hurdles. Strategies to address payment challenges included use of group visits, linked visits between billable and nonbillable providers, and development of value-based payment models. Organizational change strategies included engagement of clinical and administrative champions and co-location of services. Business case strategies involved demonstrating the ability to initially break even and potential to reduce downstream costs, while improving nonfinancial outcomes like patient satisfaction and provider burnout. Regulatory hurdles were overcome with innovative credentialing methods by leveraging available waivers and managed care contracting to expand access to IPM services. Lessons from existing programs provide direction on to grow and support such IPM delivery models across a variety of settings. PERSPECTIVE: Integrated pain management (IPM) programs face numerous implementation challenges related to payment, organizational change, care coordination, and regulatory requirements. Drawing on real-world experiences of existing programs and from diverse IPM stakeholders, we outline actionable strategies that health care systems, providers, and payers can use to expand implementation of these programs.
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Affiliation(s)
- Trevor A Lentz
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina; Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina and Washington, DC.
| | - Jonathan Gonzalez-Smith
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina and Washington, DC
| | - Katie Huber
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina and Washington, DC
| | - Christine Goertz
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina; Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina and Washington, DC
| | - William K Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina and Washington, DC
| | - Robert Saunders
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina and Washington, DC
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5
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Kerns RD, Burgess DJ, Coleman BC, Cook CE, Farrokhi S, Fritz JM, Goertz C, Heapy A, Lisi AJ, Rhon DI, Vining R. Self-Management of Chronic Pain: Psychologically Guided Core Competencies for Providers. Pain Med 2022; 23:1815-1819. [PMID: 35642906 PMCID: PMC9629397 DOI: 10.1093/pm/pnac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Robert D Kerns
- Department of Psychiatry
- Department of Neurology
- Department of Psychology, Yale University, New Haven, Connecticut
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Diana J Burgess
- VA Health Services Research and Development Service (HSR&D) Center for Care Delivery and Outcomes Research, Minneapolis VA Medical Center, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Brian C Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut
| | - Chad E Cook
- Departments of Orthopedics and Population Health Sciences, and the Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Shawn Farrokhi
- Department of Defense–Department of Veterans Affairs (DOD-VA) Extremity Trauma and Amputation Center of Excellence and Naval Medical Center, San Diego, California
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, College of Health, The University of Utah, Salt Lake City, Utah
| | - Christine Goertz
- Department of Orthopaedics, Duke University School of Medicine, and Core Faculty Member, Duke-Margolis Center for Health Policy, Durham, North Carolina
| | - Alicia Heapy
- Department of Psychiatry
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Anthony J Lisi
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut
| | - Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa, USA
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6
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Roytman GR, Coleman BC, Corcoran KL, Goertz C, Long C, Lisi A. TEMPORARY REMOVAL: Changes in the Use of Telehealth and Face-To-Face Chiropractic Care in the Department of Veterans Affairs before and after the COVID-19 Pandemic. J Manipulative Physiol Ther 2021; 44:584-590. [PMID: 35249749 PMCID: PMC8742605 DOI: 10.1016/j.jmpt.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 11/01/2022]
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7
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Ali J, Antonelli M, Bastian L, Becker W, Brandt CA, Burgess DJ, Burns A, Cohen SP, Davis AF, Dearth CL, Dziura J, Edwards R, Erdos J, Farrokhi S, Fritz J, Geda M, George SZ, Goertz C, Goodie J, Hastings SN, Heapy A, Ilfeld BM, Katsovich L, Kerns RD, Kyriakides TC, Lee A, Long CR, Luther SL, Martino S, Matheny ME, McGeary D, Midboe A, Pasquina P, Peduzzi P, Raffanello M, Rhon D, Rosen M, Esposito ER, Scarton D, Hastings SN, Seal K, Silliker N, Taylor S, Taylor SL, Tsui M, Wright FS, Zeliadt S. Optimizing the Impact of Pragmatic Clinical Trials for Veteran and Military Populations: Lessons From the Pain Management Collaboratory. Mil Med 2021; 187:179-185. [PMID: 34791412 PMCID: PMC9389906 DOI: 10.1093/milmed/usab458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 11/12/2022] Open
Abstract
Pragmatic clinical trials (PCTs) are well-suited to address unmet healthcare needs, such as those arising from the dual public health crises of chronic pain and opioid misuse, recently exacerbated by the COVID-19 pandemic. These overlapping epidemics have complex, multifactorial etiologies, and PCTs can be used to investigate the effectiveness of integrated therapies that are currently available but underused. Yet individual pragmatic studies can be limited in their reach because of existing structural and cultural barriers to dissemination and implementation. The National Institutes of Health, Department of Defense, and Department of Veterans Affairs formed an interagency research partnership, the Pain Management Collaboratory. The partnership combines pragmatic trial design with collaborative tools and relationship building within a large network to advance the science and impact of nonpharmacological approaches and integrated models of care for the management of pain and common co-occurring conditions. The Pain Management Collaboratory team supports 11 large-scale, multisite PCTs in veteran and military health systems with a focus on team science with the shared aim that the "whole is greater than the sum of the parts." Herein, we describe this integrated approach and lessons learned, including incentivizing all parties; proactively offering frequent opportunities for problem-solving; engaging stakeholders during all stages of research; and navigating competing research priorities. We also articulate several specific strategies and their practical implications for advancing pain management in active clinical, "real-world," settings.
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Affiliation(s)
- Joseph Ali
- Johns Hopkins Berman Institute of Bioethics and Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Margaret Antonelli
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Lori Bastian
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - William Becker
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Diana J Burgess
- Minneapolis VA Health Care System, Minneapolis, MN 55417, USA,University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Amy Burns
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Steven P Cohen
- Johns Hopkins Medical Institutions, Clarksville, MD 21029, USA0
| | - Alison F Davis
- Yale University School of Medicine, New Haven, CT 06520, USA
| | - Christopher L Dearth
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA,Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Jim Dziura
- Yale University School of Medicine, New Haven, CT 06520, USA
| | - Rob Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham and Women’s Hospital, Chestnut Hill, MA 02467, USA
| | - Joe Erdos
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Shawn Farrokhi
- Naval Medical Center San Diego, Department of Physical Therapy, San Diego, CA 92134, USA
| | - Julie Fritz
- University of Utah, College of Health, Salt Lake City, UT 84108, USA
| | - Mary Geda
- Yale University School of Medicine, New Haven, CT 06520, USA
| | - Steven Z George
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, NC 27715, USA
| | | | - Jeffrey Goodie
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Susan N Hastings
- Duke University School of Medicine, Durham, NC 27710, USA,Durham VA Health Care System, Durham, NC 27705, USA
| | - Alicia Heapy
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego School of Medicine, LaJolla, CA 92093, USA
| | - Lily Katsovich
- Yale University School of Medicine, New Haven, CT 06520, USA
| | - Robert D Kerns
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Tassos C Kyriakides
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Allison Lee
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, Davenport, IA 52803, USA
| | - Stephen L Luther
- James A. Haley Veterans Hospital, Tampa, FL 33612, USA,University of South Florida College of Public Health, Tampa, FL 33612, USA
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Michael E Matheny
- Tennessee Valley Healthcare System, Nashville, TN 37212, USA,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Don McGeary
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Amanda Midboe
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Paul Pasquina
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA,Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Peter Peduzzi
- Yale University School of Medicine, New Haven, CT 06520, USA
| | | | - Daniel Rhon
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Marc Rosen
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | | | - Dylan Scarton
- Henry Jackson Foundation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Susan N Hastings
- Durham VA Medical Center, Durham, NC 27701, USA,Department of Medicine, Duke University, Durham, NC 27708, USA
| | - Karen Seal
- University of California San Francisco, School of Medicine, San Francisco, CA 94143, USA,San Francisco VA Medical Center, San Francisco, CA 94121, USA
| | - Norman Silliker
- Yale University School of Medicine, New Haven, CT 06520, USA
| | - Sakasha Taylor
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Stephanie L Taylor
- VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA,University of California Los Angeles Department of Medicine and Department of Health Policy and Management, Los Angeles, CA 90095, USA
| | - Megan Tsui
- Henry Jackson Foundation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Fred S Wright
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Steven Zeliadt
- VA Puget Sound Health Care System, Seattle, WA 98108, USA,University of Washington, School of Public Health, Seattle, WA 98195, USA
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8
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Halloran SM, Coleman BC, Kawecki T, Long CR, Goertz C, Lisi AJ. Characteristics and Practice Patterns of U.S. Veterans Health Administration Doctors of Chiropractic: A Cross-sectional Survey. J Manipulative Physiol Ther 2021; 44:535-545. [DOI: 10.1016/j.jmpt.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/29/2022]
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Fritz JM, Davis AF, Burgess DJ, Coleman B, Cook C, Farrokhi S, Goertz C, Heapy A, Lisi AJ, McGeary DD, Rhon DI, Taylor SL, Zeliadt S, Kerns RD. Pivoting to virtual delivery for managing chronic pain with nonpharmacological treatments: implications for pragmatic research. Pain 2021; 162:1591-1596. [PMID: 33156148 PMCID: PMC8089114 DOI: 10.1097/j.pain.0000000000002139] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Alison F Davis
- Pain Management Collaboratory, Department of Psychiatry (dept. affiliation for Dr. Davis) Yale University School of Medicine, New Haven, CT, United States
| | - Diana J Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN, United States. Dr. Burgess is now with Department of Medicine (dept. affiliation for Dr. Burgess) University of Minnesota Medical School, Minneapolis, MN, United States
| | - Brian Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, Pain Management Collaboratory Coordinating Center, Yale School of Medicine, New Haven, CT, United States
| | - Chad Cook
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC, United States
| | - Shawn Farrokhi
- DoD-VA Extremity and Amputation Center of Excellence, Department of Physical and Occupational Therapy, Naval Medical Center, San Diego, CA, United States
| | - Christine Goertz
- Department of Orthopaedics, Duke University School of Medicine, and Core Faculty Member, Duke-Margolis Center for Health Policy, Durham, NC, United States
| | - Alicia Heapy
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States. Dr. Heapy is now with VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, Health Services Research and Development Center of Innovation, West Haven/Yale School of Medicine, New Haven, CT, United States
| | - Anthony J Lisi
- Department of Veterans Affairs, and Associate Research Scientist, Yale Center for Medical Informatics, Yale University School of Medicine, New Haven, CT, United States
| | - Donald D McGeary
- Departments of Rehabilitation Medicine and Psychiatry (Dept. affiliation for Dr. McGeary) University of Texas Health, San Antonio, TX, United States
| | - Daniel I Rhon
- Brooke Army Medical Center and Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Stephanie L Taylor
- VA HSR&D, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States. Dr. McGeary is now with Departments of Medicine and Health Policy and Management, UCLA, Los Angeles, CA, United States
| | - Steven Zeliadt
- Veterans Administration Puget Sound Health Care System, Department of Health Services, University of Washington, Seattle, WA, United States
| | - Robert D Kerns
- Departments of Psychiatry, Neurology, and Psychology, Yale University, New Haven, CT, United States. Dr. Kerns is now with VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, West Haven, CT, United States
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10
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Bastian LA, Cohen SP, Katsovich L, Becker WC, Brummett BR, Burgess DJ, Crunkhorn AE, Denneson LM, Frank JW, Goertz C, Ilfeld B, Kanzler KE, Krishnaswamy A, LaChappelle K, Martino S, Mattocks K, McGeary CA, Reznik TE, Rhon DI, Salsbury SA, Seal KH, Semiatin AM, Shin MH, Simon CB, Teyhen DS, Zamora K, Kerns RD. Stakeholder Engagement in Pragmatic Clinical Trials: Emphasizing Relationships to Improve Pain Management Delivery and Outcomes. Pain Med 2021; 21:S13-S20. [PMID: 33313726 DOI: 10.1093/pm/pnaa333] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The NIH-DOD-VA Pain Management Collaboratory (PMC) supports 11 pragmatic clinical trials (PCTs) on nonpharmacological approaches to management of pain and co-occurring conditions in U.S. military and veteran health organizations. The Stakeholder Engagement Work Group is supported by a separately funded Coordinating Center and was formed with the goal of developing respectful and productive partnerships that will maximize the ability to generate trustworthy, internally valid findings directly relevant to veterans and military service members with pain, front-line primary care clinicians and health care teams, and health system leaders. The Stakeholder Engagement Work Group provides a forum to promote success of the PCTs in which principal investigators and/or their designees discuss various stakeholder engagement strategies, address challenges, and share experiences. Herein, we communicate features of meaningful stakeholder engagement in the design and implementation of pain management pragmatic trials, across the PMC. DESIGN Our collective experiences suggest that an optimal stakeholder-engaged research project involves understanding the following: i) Who are research stakeholders in PMC trials? ii) How do investigators ensure that stakeholders represent the interests of a study's target treatment population, including individuals from underrepresented groups?, and iii) How can sustained stakeholder relationships help overcome implementation challenges over the course of a PCT? SUMMARY Our experiences outline the role of stakeholders in pain research and may inform future pragmatic trial researchers regarding methods to engage stakeholders effectively.
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Affiliation(s)
- Lori A Bastian
- VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, New Haven, CT
| | | | | | - William C Becker
- VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, New Haven, CT
| | - Bradley R Brummett
- VA Central Western Massachusetts Healthcare System, Leeds, MA.,University of Massachusetts, Amherst, MA
| | - Diana J Burgess
- VA Minneapolis Healthcare System, Minneapolis, MN.,University of Minnesota Medical School, Minneapolis, MN
| | | | | | - Joseph W Frank
- VA Eastern Colorado Health Care System, Aurora, CO.,University of Colorado School of Medicine, Aurora, CO
| | | | | | - Kathryn E Kanzler
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Akshaya Krishnaswamy
- San Francisco VA Health Care System, San Francisco, CA.,University of California, San Francisco, CA
| | | | - Steve Martino
- VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, New Haven, CT
| | - Kristin Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA.,University of Massachusetts, Amherst, MA
| | - Cindy A McGeary
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Thomas E Reznik
- Providence VA Medical Center, Providence, RI.,Warren Alpert Medical School of Brown University, Providence, RI
| | - Daniel I Rhon
- Brooke Army Medical Center, Fort Sam Houston, TX.,Uniformed Services, University of Health Sciences, Bethesda, MD
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - Karen H Seal
- San Francisco VA Health Care System, San Francisco, CA.,University of California, San Francisco, CA
| | | | | | | | | | - Kara Zamora
- San Francisco VA Health Care System, San Francisco, CA.,University of California, San Francisco, CA
| | - Robert D Kerns
- VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, New Haven, CT
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11
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Harbaugh RE, Devin C, Leavy MB, Ghogawala Z, Archer KR, Bydon M, Goertz C, Dinstein D, Nerenz DR, Eakin GS, Lavelle W, Shaffer WO, Arnold PM, Washabaugh CH, Gliklich RE. Harmonized outcome measures for use in degenerative lumbar spondylolisthesis patient registries and clinical practice. J Neurosurg Spine 2021:1-9. [PMID: 33740766 DOI: 10.3171/2020.9.spine20437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The development of new treatment approaches for degenerative lumbar spondylolisthesis (DLS) has introduced many questions about comparative effectiveness and long-term outcomes. Patient registries collect robust, longitudinal data that could be combined or aggregated to form a national and potentially international research data infrastructure to address these and other research questions. However, linking data across registries is challenging because registries typically define and capture different outcome measures. Variation in outcome measures occurs in clinical practice and other types of research studies as well, limiting the utility of existing data sources for addressing new research questions. The purpose of this project was to develop a minimum set of patient- and clinician-relevant standardized outcome measures that are feasible for collection in DLS registries and clinical practice. METHODS Nineteen DLS registries, observational studies, and quality improvement efforts were invited to participate and submit outcome measures. A stakeholder panel was organized that included representatives from medical specialty societies, health systems, government agencies, payers, industries, health information technology organizations, and patient advocacy groups. The panel categorized the measures using the Agency for Healthcare Research and Quality's Outcome Measures Framework (OMF), identified a minimum set of outcome measures, and developed standardized definitions through a consensus-based process. RESULTS The panel identified and harmonized 57 outcome measures into a minimum set of 10 core outcome measure areas and 6 supplemental outcome measure areas. The measures are organized into the OMF categories of survival, clinical response, events of interest, patient-reported outcomes, and resource utilization. CONCLUSIONS This effort identified a minimum set of standardized measures that are relevant to patients and clinicians and appropriate for use in DLS registries, other research efforts, and clinical practice. Collection of these measures across registries and clinical practice is an important step for building research data infrastructure, creating learning healthcare systems, and improving patient management and outcomes in DLS.
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Affiliation(s)
- Robert E Harbaugh
- 1Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Clinton Devin
- 2Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Zoher Ghogawala
- 4Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts.,5Tufts University School of Medicine, Boston, Massachusetts
| | - Kristin R Archer
- 6Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Mohamad Bydon
- 7Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - David R Nerenz
- 10Department of Neurosurgery, Henry Ford Medical Group, Detroit, Michigan
| | | | - William Lavelle
- 12Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | | | - Paul M Arnold
- 14Department of Neurosurgery, University of Kansas Hospital, Kansas City, Kansas
| | - Charles H Washabaugh
- 15Division of Extramural Research, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland; and
| | - Richard E Gliklich
- 3OM1, Inc., Boston, Massachusetts.,16Harvard Medical School, Boston, Massachusetts
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12
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Escolar E, Ujueta F, Kim H, Mark DB, Boineau R, Nahin RL, Goertz C, Lee KL, Anstrom KJ, Lamas GA. Possible differential benefits of edetate disodium in post-myocardial infarction patients with diabetes treated with different hypoglycemic strategies in the Trial to Assess Chelation Therapy (TACT). J Diabetes Complications 2020; 34:107616. [PMID: 32446881 PMCID: PMC9434823 DOI: 10.1016/j.jdiacomp.2020.107616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The NIH-funded Trial to Assess Chelation Therapy (TACT) randomized 1708 stable patients age ≥50 who were ≥6 months post myocardial infarction to 40 infusions of an edetate disodium-based regimen or placebo. In 633 patients with diabetes, edetate disodium significantly reduced the primary composite endpoint of mortality, recurrent myocardial infarction, stroke, coronary revascularization, or hospitalization for angina (hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.44-0.79, p < 0.001). The principal secondary endpoint of a composite of cardiovascular death, myocardial infarction, or stroke was also reduced (HR 0.60, 95% CI 0.39-0.91, p = 0.017). It is unknown if the treatment effect differs by diabetes therapy. METHODS We grouped the subset of 633 patients with diabetes according to glucose-lowering therapy at time of randomization. The log-rank test was used to compare active therapy versus placebo. All treatment comparisons were performed using 2-sided significance tests at the significance level of 0.05 and were as randomized. Relative risks were expressed as HR with associated 95% CI, calculated using the Cox proportional hazards model. RESULTS There were 162 (25.7%) patients treated with insulin; 301 (47.5%) with oral hypoglycemics only; and 170 (26.8%) receiving no pharmacologic treatment for diabetes. Patients on insulin reached the primary endpoint more frequently than patients on no pharmacologic treatment [61 (38%) vs 49 (29%) (HR 1.56, 95% CI 1.07-2.27, p = 0.022)] or oral hypoglycemics [61 (38%) vs 87 (29%) (HR 1.46, 1.05-2.03, p = 0.024)]. The primary endpoint occurred less frequently with edetate disodium based therapy versus placebo in patients on insulin [19 (26%) vs 42 (48%) (HR 0.42, 95% CI 0.25-0.74, log-rank p = 0.002)], marginally in patients on oral hypoglycemics [38 (25%) vs 49 (34%) (HR 0.66, 95% CI 0.43-1.01, log-rank p = 0.041)], and no significant difference in patients not treated with a pharmacologic therapy [23 (25%) vs 26 (34%) (HR 0.69, 95% CI 0.39-1.20, log-rank p = 0.225)]. The interaction between randomized intravenous treatment and type of diabetes therapy was not statistically significant (p = 0.203). CONCLUSIONS Edetate disodium treatment in stable, post-myocardial infarction patients with diabetes suggests that patients on insulin therapy at baseline may accrue the greatest benefit. CLINICAL TRIAL REGISTRATION clinicaltrials.gov identifier: http://clinicaltrials.gov/ct2/show/NCT00044213?term=TACT&rank=7 identifier Trial to Assess Chelation Therapy (TACT), NCT00044213.
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Affiliation(s)
- Esteban Escolar
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami, FL, United States of America
| | - Francisco Ujueta
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami, FL, United States of America
| | - Hwasoon Kim
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America; Duke University, Durham, NC, United States of America
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America; Duke University, Durham, NC, United States of America
| | - Robin Boineau
- National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America
| | - Richard L Nahin
- National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America
| | - Christine Goertz
- Duke Department of Orthopaedic Surgery, Duke University, Durham, NC, United States of America
| | - Kerry L Lee
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America; Duke University, Durham, NC, United States of America
| | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America; Duke University, Durham, NC, United States of America
| | - Gervasio A Lamas
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami, FL, United States of America.
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13
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Sewerin P, Abrar D, Lautwein A, Vordenbäumen S, Brinks R, Goertz C, Frenken M, Schneider M, Ostendorf B, Schleich C. AB0226 USING 3 TESLA MRI WITH A HIGH-RESOLUTION 16-CHANNEL HAND COIL TO DIFFERENTIATE BETWEEN RHEUMATOID AND PSORIATIC ARTHRITIS: A PILOT STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The differentiation between rheumatoid arthritis (RA) and psoriatic arthritis (PsA) is sometimes a challenge for rheumatologists in daily clinical practice. Imaging techniques such as MRI could be a helpful tool for this purpose.Objectives:To examine the value of 3 Tesla (T) magnetic resonance imaging (MRI) with a high-resolution 16-channel hand coil for the differentiation between RA and PsA.Methods:A total of 17 patients with active PsA and 27 patients with active RA were evaluated by 3T MRI. Images were analyzed by three readers according to the outcome measures for RA clinical trials (OMERACT) and RA and PsA MRI scores for the presence and intensity of the following MRI features: synovitis, flexor tenosynovitis, bone edema, bone erosion, periarticular inflammation, bone proliferation, and joint space narrowing. A receiver operating characteristics (ROC) curve was established for a calculated prediction model comprising age, gender, and the imaging features ‘periarticular inflammation’ and ‘erosion’ of the metacarpophalangeal (MCP) joint of the 5th finger.Results:PsA could be differentiated from RA by extracapsular inflammatory changes (PsAMRIS sub-score ‘periarticular inflammation’), with a minimal odds ratio (OR) for the outcome ‘not RA’ of 0.06 (p< 0.01) at all MCP joints. The calculated ROC curve had an area under the curve (AUC) of 98.1%.Conclusion:3T MRI showed a strong association of extracapsular inflammatory changes with PsA at the MCP joint level, and consequently allowed differentiation between PsA and RA.Figure 1.Receiver operating characteristics (ROC) curve with different thresholds for the calculated prediction model for the outcome RA. Area under the curve (AUC) = 98.1%.Figure 2.51-year-old female patient with PsA. MR images show flexor tenosynovitis (FS), synovitis (Syn), and periarticular inflammation (PI). A. Sagittal PD fat-saturation of D5. PI at the volar and dorsal aspects at the MCP, PIP, and DIP levels. FS at the PIP and DIP joint levels. Black asterisks indicate PI. Black arrow points to FS. B. Coronal STIR with bone edema (BE) at the proximal portion of PIP3 and 5 accompanied by PI at PIP3 and MCP, PIP and DIP5. Asterisks indicate BE. Arrowheads point to PI. C. Transversal T2 fat-saturation with FS and PI at MCP5. Arrowhead indicates FS, arrow points to volar PI. D. Transversal T1 fat-saturation following iv contrast, with FS and PI at MCP5. Arrowhead indicates FS, arrows points to volar PI.Disclosure of Interests:Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KGBristol-Myers Squibb Celgene GmbHLilly Deutschland GmbHNovartis Pharma GmbH Pfizer Deutschland GmbHRheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Daniel Abrar: None declared, Alexander Lautwein: None declared, Stefan Vordenbäumen: None declared, Ralph Brinks: None declared, Christine Goertz: None declared, Miriam Frenken: None declared, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Benedikt Ostendorf: None declared, Christoph Schleich: None declared
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14
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Lewis EF, Ujueta F, Lamas GA, Roberts RS, Mark DB, Nahin RL, Goertz C, Stylianou M, Lee KL. Differential Outcomes With Edetate Disodium-Based Treatment Among Stable Post Anterior vs. Non-Anterior Myocardial Infarction Patients. Cardiovasc Revasc Med 2020; 21:1389-1395. [PMID: 32303436 DOI: 10.1016/j.carrev.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/15/2020] [Accepted: 04/03/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Trial to Assess Chelation Therapy (TACT) found that chelation therapy significantly reduced clinical events in patients with a history of myocardial infarction (MI). The initial report of TACT included the observation of an interaction between edetate disodium infusions and MI location, as well as diabetes. Thus, we examined in greater detail the effect of edetate disodium chelation therapy as a function of MI location and diabetes. METHODS Patients (n = 1708) at least 6 weeks post-MI and age ≥ 50 were randomized to receive 40 infusions of a 500 mL chelation solution or placebo (median follow-up 55 months). The effect of edetate disodium on the primary outcome (all-cause mortality, MI, stroke, hospitalization for angina, or coronary revascularization) was assessed as a function of MI location using log-rank test and Cox regression model, adjusting for other prognostic variables. RESULTS Among patients with post anterior MI (n = 674), chelation was associated with a lower risk of the primary endpoint (HR 0.63, 95% CI 0.47-0.86, p = 0.003) among anterior MI patients, but not in post non-anterior MI (n = 1034) patients (HR 0.96, 95% CI 0.77-1.20, p = 0.702) (p-for-interaction = 0.032). The point estimates for each component of the primary endpoint favored chelation therapy. The differing treatment effect in patients with post anterior vs. non-anterior MI was consistent among patients with or without diabetes and remained significant after adjusting for other prognostic variables (p < 0.01). CONCLUSIONS Edetate disodium infusions reduced the risk of cardiovascular events among patients with a prior anterior MI. Future studies should focus on replicating these results and understanding the mechanisms of benefit.
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Affiliation(s)
- Eldrin F Lewis
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.F.L.), USA
| | - Francisco Ujueta
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (G.A.L.), USA
| | - Gervasio A Lamas
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (G.A.L.), USA.
| | | | - Daniel B Mark
- National Heart, Lung, and Blood Institute, Bethesda, MD (M.S.), USA
| | - Richard L Nahin
- The National Center for Complementary and Integrative Health, Bethesda, MD (R.L.N.), USA
| | | | - Mario Stylianou
- National Heart, Lung, and Blood Institute, Bethesda, MD (M.S.), USA
| | - Kerry L Lee
- Duke Clinical Research Institute, Durham, NC (D.B.M., K.L.L.), USA
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15
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Rist PM, Hernandez A, Bernstein C, Kowalski M, Osypiuk K, Vining R, Long CR, Goertz C, Song R, Wayne PM. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis. Headache 2019; 59:532-542. [PMID: 30973196 DOI: 10.1111/head.13501] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Several small studies have suggested that spinal manipulation may be an effective treatment for reducing migraine pain and disability. We performed a systematic review and meta-analysis of published randomized clinical trials (RCTs) to evaluate the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability. METHODS PubMed and the Cochrane Library databases were searched for clinical trials that evaluated spinal manipulation and migraine-related outcomes through April 2017. Search terms included: migraine, spinal manipulation, manual therapy, chiropractic, and osteopathic. Meta-analytic methods were employed to estimate the effect sizes (Hedges' g) and heterogeneity (I2 ) for migraine days, pain, and disability. The methodological quality of retrieved studies was examined following the Cochrane Risk of Bias Tool. RESULTS Our search identified 6 RCTs (pooled n = 677; range of n = 42-218) eligible for meta-analysis. Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability. Methodological quality varied across the studies. For example, some studies received high or unclear bias scores for methodological features such as compliance, blinding, and completeness of outcome data. Due to high levels of heterogeneity when all 6 studies were included in the meta-analysis, the 1 RCT performed only among chronic migraineurs was excluded. Heterogeneity across the remaining studies was low. We observed that spinal manipulation reduced migraine days with an overall small effect size (Hedges' g = -0.35, 95% CI: -0.53, -0.16, P < .001) as well as migraine pain/intensity. CONCLUSIONS Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta-analysis, we consider these results to be preliminary. Methodologically rigorous, large-scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.
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Affiliation(s)
- Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Audrey Hernandez
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Carolyn Bernstein
- Osher Clinic Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew Kowalski
- Osher Clinic Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Kamila Osypiuk
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Rhayun Song
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Peter M Wayne
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
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Frenken M, Schleich C, Brinks R, Abrar DB, Goertz C, Schneider M, Ostendorf B, Sewerin P. The value of the simplified RAMRIS-5 in early RA patients under methotrexate therapy using high-field MRI. Arthritis Res Ther 2019; 21:21. [PMID: 30642376 PMCID: PMC6332674 DOI: 10.1186/s13075-018-1789-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 12/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate a simplified version of the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) for five joints of the hand (RAMRIS-5) in patients with early rheumatoid arthritis (RA) before and after the initiation of methotrexate (MTX) therapy using high-resolution, 3-T magnetic resonance imaging (MRI). METHODS Twenty-eight patients with a seropositive, early RA (disease duration of less than 6 months (range 2-23 weeks)) according to 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria (mean age 56.8 years, range 39-74) were prospectively assessed with a baseline investigation including clinical assessment (disease activity score of 28 joints (DAS-28) and C-reactive protein (CRP)) and 3-T MRI of the clinically dominant hand. Follow-up visits were performed 3 and 6 months after initiation of a MTX therapy at baseline. MRI scans were analyzed in accordance with RAMRIS and the simplified RAMRIS-5. RESULTS DAS-28 and CRP decreased significantly after initiation of MTX therapy. Even though erosion scores increased over time, RAMRIS and RAMRIS-5 also decreased significantly after the start of therapy. There was a strong correlation between the total RAMRIS-5 and RAMRIS at baseline (r = 0.838; P <0.001) and follow-up (3 months: r = 0.876; P <0.001; 6 months: r = 0.897; P <0.001). In the short term (3-month follow-up), RAMRIS and RAMRIS-5 demonstrated similar ability to detect changes for all subgroups (bone edema, erosion, and synovitis). In the long-term comparison (6-month follow-up), RAMRIS-5 also showed similar effectiveness when detecting changes in bone edema and erosion compared with RAMRIS. Deviations occurred regarding only synovitis, where change was slightly higher in RAMRIS-5: SRM (RAMRIS) = 0.07 ± 0.14; SRM (RAMRIS-5) = 0.34 ± 0.06. CONCLUSIONS Three-Tesla MRI-based RAMRIS-5 is a simplified and resource-saving RAMRIS score which compares favorably with the RAMRIS when detecting changes in early RA. Even though there is a slight abbreviation between RAMRIS-5 and the original score regarding the change of synovitis, it may be used for diagnosis and therapy monitoring in follow-up evaluations.
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Affiliation(s)
- Miriam Frenken
- Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christoph Schleich
- Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Ralph Brinks
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Daniel Benjamin Abrar
- Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christine Goertz
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Matthias Schneider
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Benedikt Ostendorf
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Philipp Sewerin
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
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DeVocht JW, Vining R, Smith DL, Long C, Jones T, Goertz C. Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial. Trials 2019; 20:5. [PMID: 30606225 PMCID: PMC6318970 DOI: 10.1186/s13063-018-3133-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/13/2018] [Indexed: 01/09/2023] Open
Abstract
Background Chiropractic manipulative therapy (CMT) has been shown to improve reaction time in some clinical studies. Slight changes in reaction time can be critical for military personnel, such as special operation forces (SOF). This trial was conducted to test whether CMT could lead to improved reaction and response time in combat-ready SOF-qualified personnel reporting little or no pain. Methods This prospective, randomized controlled trial was conducted at Blanchfield Army Community Hospital, Fort Campbell, KY, USA. Active-duty US military participants over the age of 19 years carrying an SOF designation were eligible. Participants were randomly allocated to CMT or wait-list control. One group received four CMT treatments while the other received no treatment within the 2-week trial period. Assessment included simple hand/foot reaction time, choice reaction time, and Fitts’ Law and whole-body response time. On visits 1 and 5, the same five assessments were conducted immediately pre- and post-treatment for the CMT group and before and after a 10-min wait period for the wait-list group. Primary outcomes included between-group differences for the pre-CMT/wait-list period at visit 1 and visit 5 for each test. Secondary outcomes included between-group differences in immediate pre- and post-(within visit) changes. Analysis of covariance was used for all data analysis. Results One hundred and seventy-five SOF-qualified personnel were screened for eligibility; 120 participants were enrolled, with 60 randomly allocated to each group. Due to technical problems resulting in inconsistent data collection, data from 77 participants were analyzed for simple hand/foot reaction time. The mean ± standard deviation (SD) age was 33.0 ± 5.6 years and all participants were male. No between-group statistically significant differences were found for any of the five biomechanical tests, except immediate pre- and post-changes in favor of the CMT group in whole-body response time at both assessment visits. There were four adverse events, none related to trial participation. Conclusions A single session of CMT was shown to have an immediate effect of reducing the time required for asymptomatic SOF qualified personnel to complete a complex whole-body motor response task. However, sustained reduction in reaction or response time from five tests compared with a wait-list control group was not observed following three sessions of CMT. Trial registration ClinicalTrials.gov, NCT02168153. Registered on 12 June 2014.
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Affiliation(s)
- James W DeVocht
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St., Davenport, IA, 52803, USA
| | - Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St., Davenport, IA, 52803, USA.
| | - Dean L Smith
- Department of Kinesiology and Health, 26E Phillips Hall, Miami University, Oxford, OH, 45056, USA
| | - Cynthia Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St., Davenport, IA, 52803, USA
| | - Thomas Jones
- Chiropractic Clinic, Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY, 42223-5349, USA
| | - Christine Goertz
- Present Address: The Spine Institute for Quality (Spine IQ), Davenport, IA, USA
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18
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Kawchuk G, Goertz C, Axén I, Descarreaux M, French S, Haas M, Hartvigsen J, Kolberg C, Jenkins H, Peterson C, Taylor J. Letter to the Editor Re: Oakley PA, Cuttler JM, Harrison DE. X-Ray Imaging Is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks. Dose Response. 2018 Jun 19;16(2). Dose Response 2018; 16:1559325818811521. [PMID: 30627066 PMCID: PMC6311565 DOI: 10.1177/1559325818811521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/25/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- Greg Kawchuk
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Iben Axén
- Karolinska Institute, Solna, Stockholm, Sweden
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19
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Forsythe LP, Frank LB, Hemphill R, Tafari AT, Szydlowski V, Lauer M, Goertz C, Clauser S. Researchers, Patients, and Stakeholders Evaluating Comparative-Effectiveness Research: A Mixed-Methods Study of the PCORI Reviewer Experience. Value Health 2018; 21:1161-1167. [PMID: 30314616 DOI: 10.1016/j.jval.2018.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 03/07/2018] [Accepted: 03/28/2018] [Indexed: 05/06/2023]
Abstract
OBJECTIVES The Patient-Centered Outcomes Research Institute (PCORI) includes patients and stakeholders alongside scientists in reviewing research applications using unique review criteria including patient-centeredness and patient and/or stakeholder engagement. To support extension of this unique collaborative model to other funders, information from the reviewers on the review process is needed to understand how scientists and nonscientists evaluate research proposals together. Thus, this study aimed to describe reviewers' perspectives of the interactions during the in-person review panel; to examine the value and challenges of including scientists, patients, and stakeholders together; and to understand the perceived importance of PCORI's review criteria. METHODS This study utilized anonymous, cross-sectional surveys (N = 925 respondents from 5 funding cycles: 470 scientists, 217 patients, 238 stakeholders; survey completion rates by cycle: 70-89%) and group interviews (N = 18). RESULTS Reviewers of all types describe PCORI Merit Review as respectful, balanced, and one of reciprocal influence among different reviewer types. Reviewers indicate strong support and value of input from all reviewer types, receptivity to input from others, and the panel chair's incorporation of all views. Patients and stakeholders provide real-world perspectives on importance to patients, research partnership plans, and study feasibility. Challenges included concerns about a lack of technical expertise of patient/stakeholder reviewers and about scientists dominating conversations. The most important criterion for assigning final review scores was technical merit-either alone or in conjunction with patient-centeredness or patient/ stakeholder engagement. CONCLUSIONS PCORI Merit Reviewers' self-reports indicate that the perspectives of different reviewer types are influential in panel discussions and Merit Review outcomes.
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Affiliation(s)
- Laura P Forsythe
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA.
| | - Lori B Frank
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA
| | - Rachel Hemphill
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA
| | - A Tsahai Tafari
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA
| | | | | | | | - Steven Clauser
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA
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20
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Forsythe LP, Frank LB, Tafari AT, Cohen SS, Lauer M, Clauser S, Goertz C, Schrandt S. Unique Review Criteria and Patient and Stakeholder Reviewers: Analysis of PCORI's Approach to Research Funding. Value Health 2018; 21:1152-1160. [PMID: 30314615 DOI: 10.1016/j.jval.2018.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 02/15/2018] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The Patient-Centered Outcomes Research Institute (PCORI) uses a unique approach to Merit Review that includes patients and stakeholders as reviewers with scientists, and includes unique review criteria (patient-centeredness and active engagement of end users in the research). This study assessed the extent to which different reviewer types influence review scores and funding outcomes, the emphasis placed on technical merit compared to other criteria by a multistakeholder panel, and the impact of the in-person discussion on agreement among different reviewer types. METHODS Cross-sectional analysis of administrative data from PCORI online and in-person Merit Review (N = 1312 applications from the five funding cycles from November 2013 to August 2015). Linear and logistic regression models were used to analyze the data. RESULTS For all reviewer types, final review scores were associated with at least one review criterion score from each of the three reviewer types. The strongest predictor of final overall scores for all reviewer types was scientists' prediscussion ratings of technical merit. All reviewers' prediscussion ratings of the potential to improve health care and outcomes, and scientists' ratings of technical merit and patient-centeredness, were associated with funding success. For each reviewer type, overall impact scores from the online scoring were changed on at least half of the applications at the in-person panel discussion. Score agreement across reviewer types was greater after panel discussion. CONCLUSIONS Scientist, patient, and stakeholder views all contribute to PCORI Merit Review of applications for research funding. Technical merit is critical to funding success but patient and stakeholder ratings of other criteria also influence application disposition.
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Affiliation(s)
- Laura P Forsythe
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA.
| | - Lori B Frank
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA
| | - A Tsahai Tafari
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA
| | | | | | - Steven Clauser
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA
| | | | - Suzanne Schrandt
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, USA; Arthritis Foundation, Washington, DC, USA
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21
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Haldeman S, Nordin M, Chou R, Côté P, Hurwitz EL, Johnson CD, Randhawa K, Green BN, Kopansky-Giles D, Acaroğlu E, Ameis A, Cedraschi C, Aartun E, Adjei-Kwayisi A, Ayhan S, Aziz A, Bas T, Blyth F, Borenstein D, Brady O, Brooks P, Camilleri C, Castellote JM, Clay MB, Davatchi F, Dudler J, Dunn R, Eberspaecher S, Emmerich J, Farcy JP, Fisher-Jeffes N, Goertz C, Grevitt M, Griffith EA, Hajjaj-Hassouni N, Hartvigsen J, Hondras M, Kane EJ, Laplante J, Lemeunier N, Mayer J, Mior S, Mmopelwa T, Modic M, Moss J, Mullerpatan R, Muteti E, Mwaniki L, Ngandeu-Singwe M, Outerbridge G, Rajasekaran S, Shearer H, Smuck M, Sönmez E, Tavares P, Taylor-Vaisey A, Torres C, Torres P, van der Horst A, Verville L, Vialle E, Kumar GV, Vlok A, Watters W, Wong CC, Wong JJ, Yu H, Yüksel S. The Global Spine Care Initiative: World Spine Care executive summary on reducing spine-related disability in low- and middle-income communities. Eur Spine J 2018; 27:776-785. [PMID: 30151809 DOI: 10.1007/s00586-018-5722-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Spinal disorders, including back and neck pain, are major causes of disability, economic hardship, and morbidity, especially in underserved communities and low- and middle-income countries. Currently, there is no model of care to address this issue. This paper provides an overview of the papers from the Global Spine Care Initiative (GSCI), which was convened to develop an evidence-based, practical, and sustainable, spinal healthcare model for communities around the world with various levels of resources. METHODS Leading spine clinicians and scientists around the world were invited to participate. The interprofessional, international team consisted of 68 members from 24 countries, representing most disciplines that study or care for patients with spinal symptoms, including family physicians, spine surgeons, rheumatologists, chiropractors, physical therapists, epidemiologists, research methodologists, and other stakeholders. RESULTS Literature reviews on the burden of spinal disorders and six categories of evidence-based interventions for spinal disorders (assessment, public health, psychosocial, noninvasive, invasive, and the management of osteoporosis) were completed. In addition, participants developed a stratification system for surgical intervention, a classification system for spinal disorders, an evidence-based care pathway, and lists of resources and recommendations to implement the GSCI model of care. CONCLUSION The GSCI proposes an evidence-based model that is consistent with recent calls for action to reduce the global burden of spinal disorders. The model requires testing to determine feasibility. If it proves to be implementable, this model holds great promise to reduce the tremendous global burden of spinal disorders. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Scott Haldeman
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, University of California, Irvine, Irvine, CA, USA.,World Spine Care, Santa Ana, CA, USA
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA.,World Spine Care Europe, Holmfirth, UK
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'i, Mānoa, Honolulu, HI, USA
| | - Claire D Johnson
- National University of Health Sciences, Lombard, IL, USA. .,Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA.
| | - Kristi Randhawa
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Bart N Green
- National University of Health Sciences, Lombard, IL, USA.,Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA
| | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Arthur Ameis
- Certification Program in Insurance Medicine and MedicoLegal Expertise, Faculty of Medicine, University of Montreal, Toronto, ON, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Ellen Aartun
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Afua Adjei-Kwayisi
- Ridge Regional Hospital, Ghana World Spine Care, Accra, Greater Accra, Ghana
| | - Selim Ayhan
- ARTES Spine Center, Acibadem University, Ankara, Turkey
| | - Amer Aziz
- Orthopaedics and Spine Department, Ghurki Trust Teaching Hospital Lahore Pakistan, Lahore, Punjab, Pakistan
| | - Teresa Bas
- Department of Surgery, Hospital Universitario and Politecnico La Fe, Valencia University, Valencia, Spain
| | - Fiona Blyth
- Concord Clinical School, University of Sydney, Concord, NSW, Australia
| | - David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, Potomac, MD, USA
| | | | - Peter Brooks
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Toorak, Melbourne, VIC, Australia
| | | | - Juan M Castellote
- National School of Occupational Medicine, Carlos III Institute of Health, Madrid, Spain.,Physical Medicine and Rehabilitation Department, University Complutense, Madrid, Spain
| | - Michael B Clay
- Rehabilitation Care Line, Physical Medicine and Rehabilitation, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Jean Dudler
- Department of Rheumatology, HFR Fribourg - Hospital Cantonal, Fribourg, FR, Switzerland
| | - Robert Dunn
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa.,Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | | | - Juan Emmerich
- University of La Plata, La Plata, Buenos Aires, Argentina
| | - Jean Pierre Farcy
- Department of Orthopedic Surgery (retired), New York University, Piermont, NY, USA
| | - Norman Fisher-Jeffes
- Groote Schuur Hospital, Cape Town, Western Cape, South Africa.,Panorama Medi Clinic, Cape Town, Western Cape, South Africa
| | - Christine Goertz
- Palmer College of Chiropractic, Davenport, IA, USA.,The Spine Institute for Quality, Davenport, IA, USA
| | | | | | | | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Maria Hondras
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Edward J Kane
- College of Rehabilitative Sciences, Doctor of Physical Therapy Program, University of St. Augustine for Health Sciences, San Marcos, CA, USA
| | - Julie Laplante
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
| | | | - John Mayer
- U.S. Spine and Sport Foundation, San Diego, CA, USA
| | - Silvano Mior
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Tiro Mmopelwa
- ARTES Ankara Spine Centre, Life Gaborone Hospital, Gaborone, Botswana
| | - Michael Modic
- Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Jean Moss
- Canadian Memorial Chiropractic College, President Emerita, Toronto, ON, Canada
| | - Rajani Mullerpatan
- MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Elijah Muteti
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Madeleine Ngandeu-Singwe
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Center Region, Cameroon
| | - Geoff Outerbridge
- World Spine Care and Canadian Memorial Chiropractic College, Chelsea, QC, Canada
| | | | - Heather Shearer
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Erkin Sönmez
- Department of Neurological Surgery, Başkent University School of Medicine, Ankara, Turkey
| | | | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Carlos Torres
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Paola Torres
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Alexander van der Horst
- Department of Surgery, University of Namibia, Windhoek, Namibia.,Central Hospital, Windhoek, Namibia
| | - Leslie Verville
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | | | | | - Adriaan Vlok
- Division of Neurosurgery, University of Stellenbosch, Bellville, Western Cape, South Africa
| | - William Watters
- Department of Orthopedic, Weill Cornell Medical School and Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA.,Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Jessica J Wong
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Hainan Yu
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Selcen Yüksel
- Department of Biostatistics, Ankara Yildirim Beyazit University Medical School, Ankara, Turkey
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Kopansky-Giles D, Johnson CD, Haldeman S, Chou R, Côté P, Green BN, Nordin M, Acaroğlu E, Ameis A, Cedraschi C, Hurwitz EL, Ayhan S, Borenstein D, Brady O, Brooks P, Davatchi F, Dunn R, Goertz C, Hajjaj-Hassouni N, Hartvigsen J, Hondras M, Lemeunier N, Mayer J, Mior S, Moss J, Mullerpatan R, Muteti E, Mwaniki L, Ngandeu-Singwe M, Outerbridge G, Randhawa K, Torres C, Torres P, Vlok A, Wong CC. The Global Spine Care Initiative: resources to implement a spine care program. Eur Spine J 2018; 27:915-924. [PMID: 30151804 DOI: 10.1007/s00586-018-5725-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of this report is to describe the development of a list of resources necessary to implement a model of care for the management of spine-related concerns anywhere in the world, but especially in underserved communities and low- and middle-income countries. METHODS Contents from the Global Spine Care Initiative (GSCI) Classification System and GSCI care pathway papers provided a foundation for the resources list. A seed document was developed that included resources for spine care that could be delivered in primary, secondary and tertiary settings, as well as resources needed for self-care and community-based settings for a wide variety of spine concerns (e.g., back and neck pain, deformity, spine injury, neurological conditions, pathology and spinal diseases). An iterative expert consensus process was used using electronic surveys. RESULTS Thirty-five experts completed the process. An iterative consensus process was used through an electronic survey. A consensus was reached after two rounds. The checklist of resources included the following categories: healthcare provider knowledge and skills, materials and equipment, human resources, facilities and infrastructure. The list identifies resources needed to implement a spine care program in any community, which are based upon spine care needs. CONCLUSION To our knowledge, this is the first international and interprofessional attempt to develop a list of resources needed to deliver care in an evidence-based care pathway for the management of people presenting with spine-related concerns. This resource list needs to be field tested in a variety of communities with different resource capacities to verify its utility. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Claire D Johnson
- National University of Health Sciences, Lombard, IL, USA.
- Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA.
| | - Scott Haldeman
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurology, University of California, Irvine, Irvine, CA, USA
- World Spine Care, Santa Ana, CA, USA
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Bart N Green
- National University of Health Sciences, Lombard, IL, USA
- Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA
- World Spine Care Europe, Holmfirth, UK
| | | | - Arthur Ameis
- Certification Program in Insurance Medicine and MedicoLegal Expertise, University of Montreal Faculty of Medicine, Toronto, ON, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'I, Mānoa, Honolulu, HI, USA
| | - Selim Ayhan
- ARTES Spine Center, Acibadem University, Ankara, Turkey
| | - David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, Potomac, MD, USA
| | | | - Peter Brooks
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Toorak, Melbourne, VIC, Australia
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Robert Dunn
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
- Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Christine Goertz
- Palmer College of Chiropractic, Davenport, IA, USA
- The Spine Institute for Quality, Davenport, IA, USA
| | | | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Maria Hondras
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - John Mayer
- U.S. Spine and Sport Foundation, San Diego, CA, USA
| | - Silvano Mior
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Jean Moss
- Canadian Memorial Chiropractic College, President Emerita, Toronto, ON, Canada
| | - Rajani Mullerpatan
- MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Elijah Muteti
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Madeleine Ngandeu-Singwe
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Center Region, Cameroon
| | - Geoff Outerbridge
- World Spine Care and Canadian Memorial Chiropractic College, Chelsea, QC, Canada
| | - Kristi Randhawa
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Carlos Torres
- University of Ottawa, Ottawa, ON, Canada
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Paola Torres
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Adriaan Vlok
- Division of Neurosurgery, University of Stellenbosch, Bellville, Western Cape, South Africa
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23
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Haldeman S, Johnson CD, Chou R, Nordin M, Côté P, Hurwitz EL, Green BN, Kopansky-Giles D, Cedraschi C, Aartun E, Acaroğlu E, Ameis A, Ayhan S, Blyth F, Borenstein D, Brady O, Davatchi F, Goertz C, Hajjaj-Hassouni N, Hartvigsen J, Hondras M, Lemeunier N, Mayer J, Mior S, Mmopelwa T, Modic M, Mullerpatan R, Mwaniki L, Ngandeu-Singwe M, Outerbridge G, Randhawa K, Sönmez E, Torres C, Torres P, Watters W, Yu H. The Global Spine Care Initiative: classification system for spine-related concerns. Eur Spine J 2018; 27:889-900. [PMID: 30151807 DOI: 10.1007/s00586-018-5724-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this report is to describe the development of a classification system that would apply to anyone with a spine-related concern and that can be used in an evidence-based spine care pathway. METHODS Existing classification systems for spinal disorders were assembled. A seed document was developed through round-table discussions followed by a modified Delphi process. International and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. RESULTS Thirty-six experts from 15 countries participated. After the second round, there was 95% agreement of the proposed classification system. The six major classifications included: no or minimal symptoms (class 0); mild symptoms (i.e., neck or back pain) but no interference with activities (class I); moderate or severe symptoms with interference of activities (class II); spine-related neurological signs or symptoms (class III); severe bony spine deformity, trauma or pathology (class IV); and spine-related symptoms or destructive lesions associated with systemic pathology (class V). Subclasses for each major class included chronicity and severity when different interventions were anticipated or recommended. CONCLUSIONS An international and interprofessional group developed a comprehensive classification system for all potential presentations of people who may seek care or advice at a spine care program. This classification can be used in the development of a spine care pathway, in clinical practice, and for research purposes. This classification needs to be tested for validity, reliability, and consistency among clinicians from different specialties and in different communities and cultures. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Scott Haldeman
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, University of California, Irvine, Irvine, CA, USA.,World Spine Care, Santa Ana, CA, USA
| | - Claire D Johnson
- National University of Health Sciences, Lombard, IL, USA. .,Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA.
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA.,World Spine Care Europe, Holmfirth, UK
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'i, Mānoa, Honolulu, HI, USA
| | - Bart N Green
- National University of Health Sciences, Lombard, IL, USA.,Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA
| | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Ellen Aartun
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | | | - Arthur Ameis
- Faculty of Medicine, Certification Program in Insurance Medicine and MedicoLegal Expertise, University of Montreal, Toronto, ON, Canada
| | - Selim Ayhan
- ARTES Spine Center, Acibadem University, Ankara, Turkey
| | - Fiona Blyth
- Concord Clinical School, University of Sydney, Concord, NSW, Australia
| | - David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, Potomac, MD, USA
| | | | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Christine Goertz
- Palmer College of Chiropractic, Davenport, IA, USA.,The Spine Institute for Quality, Davenport, IA, USA
| | | | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Maria Hondras
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - John Mayer
- U.S. Spine and Sport Foundation, San Diego, CA, USA
| | - Silvano Mior
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Tiro Mmopelwa
- ARTES Ankara Spine Centre, Life Gaborone Hospital, Gaborone, Botswana
| | - Michael Modic
- Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Rajani Mullerpatan
- Mahatma Gandhi Mission Institute of Health Sciences, MGM School of Physiotherapy, Navi Mumbai, Maharashtra, India
| | | | - Madeleine Ngandeu-Singwe
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Center Region, Cameroon
| | - Geoff Outerbridge
- World Spine Care and Canadian Memorial Chiropractic College, Chelsea, QC, Canada
| | - Kristi Randhawa
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Erkin Sönmez
- Department of Neurological Surgery, School of Medicine, Başkent University, Ankara, Turkey
| | - Carlos Torres
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Paola Torres
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - William Watters
- Department of Orthopedic, Weill Cornell Medical School and Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA.,Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Hainan Yu
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
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24
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Johnson CD, Haldeman S, Nordin M, Chou R, Côté P, Hurwitz EL, Green BN, Kopansky-Giles D, Randhawa K, Cedraschi C, Ameis A, Acaroğlu E, Aartun E, Adjei-Kwayisi A, Ayhan S, Aziz A, Bas T, Blyth F, Borenstein D, Brady O, Brooks P, Camilleri C, Castellote JM, Clay MB, Davatchi F, Dudler J, Dunn R, Eberspaecher S, Emmerich J, Farcy JP, Fisher-Jeffes N, Goertz C, Grevitt M, Griffith EA, Hajjaj-Hassouni N, Hartvigsen J, Hondras M, Kane EJ, Laplante J, Lemeunier N, Mayer J, Mior S, Mmopelwa T, Modic M, Moss J, Mullerpatan R, Muteti E, Mwaniki L, Ngandeu-Singwe M, Outerbridge G, Rajasekaran S, Shearer H, Smuck M, Sönmez E, Tavares P, Taylor-Vaisey A, Torres C, Torres P, van der Horst A, Verville L, Vialle E, Kumar GV, Vlok A, Watters W, Wong CC, Wong JJ, Yu H, Yüksel S. The Global Spine Care Initiative: methodology, contributors, and disclosures. Eur Spine J 2018; 27:786-795. [PMID: 30151808 DOI: 10.1007/s00586-018-5723-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this report is to describe the Global Spine Care Initiative (GSCI) contributors, disclosures, and methods for reporting transparency on the development of the recommendations. METHODS World Spine Care convened the GSCI to develop an evidence-based, practical, and sustainable healthcare model for spinal care. The initiative aims to improve the management, prevention, and public health for spine-related disorders worldwide; thus, global representation was essential. A series of meetings established the initiative's mission and goals. Electronic surveys collected contributorship and demographic information, and experiences with spinal conditions to better understand perceptions and potential biases that were contributing to the model of care. RESULTS Sixty-eight clinicians and scientists participated in the deliberations and are authors of one or more of the GSCI articles. Of these experts, 57 reported providing spine care in 34 countries, (i.e., low-, middle-, and high-income countries, as well as underserved communities in high-income countries.) The majority reported personally experiencing or having a close family member with one or more spinal concerns including: spine-related trauma or injury, spinal problems that required emergency or surgical intervention, spinal pain referred from non-spine sources, spinal deformity, spinal pathology or disease, neurological problems, and/or mild, moderate, or severe back or neck pain. There were no substantial reported conflicts of interest. CONCLUSION The GSCI participants have broad professional experience and wide international distribution with no discipline dominating the deliberations. The GSCI believes this set of papers has the potential to inform and improve spine care globally. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Claire D Johnson
- National University of Health Sciences, Lombard, IL, USA. .,Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA.
| | - Scott Haldeman
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, University of California, Irvine, Irvine, CA, USA.,World Spine Care, Santa Ana, CA, USA
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA.,World Spine Care Europe, Holmfirth, UK
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawaii, Mānoa, Honolulu, HI, USA
| | - Bart N Green
- National University of Health Sciences, Lombard, IL, USA.,Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA
| | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, North York, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristi Randhawa
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Arthur Ameis
- University of Montreal Faculty of Medicine Certification Program in Insurance Medicine and MedicoLegal Expertise, Toronto, ON, Canada
| | | | - Ellen Aartun
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Afua Adjei-Kwayisi
- Ghana World Spine Care, Ridge Regional Hospital, Accra, Greater Accra, Ghana
| | - Selim Ayhan
- ARTES Spine Center, Acibadem University, Ankara, Turkey
| | - Amer Aziz
- Orthopaedics and Spine Department, Ghurki Trust Teaching Hospital Lahore Pakistan, Lahore, Punjab, Pakistan
| | - Teresa Bas
- Department of Surgery, Hospital Universitario and Politecnico La Fe, Valencia University, Valencia, Spain
| | - Fiona Blyth
- Concord Clinical School, University of Sydney, Concord, NSW, Australia
| | - David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, Potomac, MD, USA
| | | | - Peter Brooks
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Toorak, Melbourne, VIC, Australia
| | | | - Juan M Castellote
- National School of Occupational Medicine, Carlos III Institute of Health and Physical Medicine and Rehabilitation Department, University Complutense, Madrid, Spain
| | - Michael B Clay
- Rehabilitation Care Line, Physical Medicine and Rehabilitation, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Jean Dudler
- Department of Rheumatology, HFR Fribourg - Hospital Cantonal, Fribourg, FR, Switzerland
| | - Robert Dunn
- Department of Orthopaedic Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | | | - Juan Emmerich
- University of La Plata, La Plata, Buenos Aires, Argentina
| | | | - Norman Fisher-Jeffes
- Panorama Medi Clinic, Cape Town, Western Cape, South Africa.,Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Christine Goertz
- Palmer College of Chiropractic and The Spine Institute for Quality, Davenport, IA, USA
| | | | | | | | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Maria Hondras
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Edward J Kane
- College of Rehabilitative Sciences, Doctor of Physical Therapy Program, University of St. Augustine for Health Sciences, San Marcos, CA, USA
| | - Julie Laplante
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
| | | | - John Mayer
- U.S. Spine and Sport Foundation, San Diego, CA, USA
| | - Silvano Mior
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Tiro Mmopelwa
- ARTES Ankara Spine Centre, Life Gaborone Hospital, Gaborone, Botswana
| | - Michael Modic
- Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Jean Moss
- Canadian Memorial Chiropractic College, President Emerita, Toronto, ON, Canada
| | - Rajani Mullerpatan
- MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Elijah Muteti
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Madeleine Ngandeu-Singwe
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Center Region, Cameroon
| | - Geoff Outerbridge
- World Spine Care and Canadian Memorial Chiropractic College, Chelsea, QC, Canada
| | | | - Heather Shearer
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Erkin Sönmez
- Department of Neurological Surgery, Başkent University School of Medicine, Ankara, Turkey
| | | | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Carlos Torres
- Department of Medical Imaging, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Paola Torres
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Alexander van der Horst
- Department of Surgery, University of Namibia, Windhoek, Namibia.,Central Hospital, Windhoek, Namibia
| | - Leslie Verville
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | | | - Gomatam Vijay Kumar
- Head of Neurosurgery, AMRI Hospitals, Salt Lake, Kolkata, West Bengal, India
| | - Adriaan Vlok
- Division of Neurosurgery, University of Stellenbosch, Bellville, Western Cape, South Africa
| | - William Watters
- Department of Orthopedic, Weill Cornell Medical School and Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA.,Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Jessica J Wong
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Hainan Yu
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Selcen Yüksel
- Department of Biostatistics, Ankara Yildirim Beyazit University Medical School, Ankara, Turkey
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25
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Haldeman S, Johnson CD, Chou R, Nordin M, Côté P, Hurwitz EL, Green BN, Cedraschi C, Acaroğlu E, Kopansky-Giles D, Ameis A, Adjei-Kwayisi A, Ayhan S, Blyth F, Borenstein D, Brady O, Brooks P, Camilleri C, Castellote JM, Clay MB, Davatchi F, Dunn R, Goertz C, Griffith EA, Hondras M, Kane EJ, Lemeunier N, Mayer J, Mmopelwa T, Modic M, Moss J, Mullerpatan R, Muteti E, Mwaniki L, Ngandeu-Singwe M, Outerbridge G, Randhawa K, Shearer H, Sönmez E, Torres C, Torres P, Verville L, Vlok A, Watters W, Wong CC, Yu H. The Global Spine Care Initiative: care pathway for people with spine-related concerns. Eur Spine J 2018; 27:901-914. [PMID: 30151811 DOI: 10.1007/s00586-018-5721-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this report is to describe the development of an evidence-based care pathway that can be implemented globally. METHODS The Global Spine Care Initiative (GSCI) care pathway development team extracted interventions recommended for the management of spinal disorders from six GSCI articles that synthesized the available evidence from guidelines and relevant literature. Sixty-eight international and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. An iterative consensus process was used. RESULTS After three rounds of review, 46 experts from 16 countries reached consensus for the care pathway that includes five decision steps: awareness, initial triage, provider assessment, interventions (e.g., non-invasive treatment; invasive treatment; psychological and social intervention; prevention and public health; specialty care and interprofessional management), and outcomes. The care pathway can be used to guide the management of patients with any spine-related concern (e.g., back and neck pain, deformity, spinal injury, neurological conditions, pathology, spinal diseases). The pathway is simple and can be incorporated into educational tools, decision-making trees, and electronic medical records. CONCLUSION A care pathway for the management of individuals presenting with spine-related concerns includes evidence-based recommendations to guide health care providers in the management of common spinal disorders. The proposed pathway is person-centered and evidence-based. The acceptability and utility of this care pathway will need to be evaluated in various communities, especially in low- and middle-income countries, with different cultural background and resources. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Scott Haldeman
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurology, University of California, Irvine, Irvine, CA, USA
- World Spine Care, Santa Ana, CA, USA
| | - Claire D Johnson
- National University of Health Sciences, Lombard, IL, USA.
- Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA.
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology and Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA
- World Spine Care Europe, Holmfirth, UK
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'i, Mānoa, Honolulu, HI, USA
| | - Bart N Green
- National University of Health Sciences, Lombard, IL, USA
- Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA
| | - Christine Cedraschi
- Division of General Medical Rehabilitation and Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | | | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, North York, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Arthur Ameis
- Faculty of Medicine Certification Program in Insurance Medicine and MedicoLegal Expertise, University of Montreal, Toronto, ON, Canada
| | - Afua Adjei-Kwayisi
- Ridge Regional Hospital, Ghana World Spine Care, Accra, Greater Accra, Ghana
| | - Selim Ayhan
- ARTES Spine Center, Acibadem University, Ankara, Turkey
| | - Fiona Blyth
- Concord Clinical School, University of Sydney, Concord, NSW, Australia
| | - David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, Potomac, MD, USA
| | | | - Peter Brooks
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Toorak, Melbourne, VIC, Australia
| | | | - Juan M Castellote
- National School of Occupational Medicine, Carlos III Institute of Health and Physical Medicine and Rehabilitation, University of Complutense, Madrid, Madrid, Spain
| | - Michael B Clay
- Rehabilitation Care Line, Physical Medicine and Rehabilitation, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Robert Dunn
- Department of Orthopaedic Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Christine Goertz
- Palmer College of Chiropractic, Davenport, IA, USA
- The Spine Institute for Quality, Davenport, IA, USA
| | | | - Maria Hondras
- Department of Anesthesiology, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Edward J Kane
- College of Rehabilitative Sciences, Doctor of Physical Therapy Program, University of St. Augustine for Health Sciences, San Marcos, CA, USA
| | | | - John Mayer
- U.S. Spine & Sport Foundation, San Diego, CA, USA
| | - Tiro Mmopelwa
- ARTES Ankara Spine Centre, Life Gaborone Hospital, Gaborone, Botswana
| | - Michael Modic
- Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Jean Moss
- Canadian Memorial Chiropractic College, President Emerita, Toronto, ON, Canada
| | - Rajani Mullerpatan
- Mahatma Gandhi Mission Institute of Health Sciences, MGM School of Physiotherapy, Navi Mumbai, Maharashtra, India
| | - Elijah Muteti
- Moi University/Moi Teaching & Referral Hospital, Eldoret, Kenya
| | | | - Madeleine Ngandeu-Singwe
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Center Region, Cameroon
| | - Geoff Outerbridge
- World Spine Care and Canadian Memorial Chiropractic College, Chelsea, QC, Canada
| | - Kristi Randhawa
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Heather Shearer
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Erkin Sönmez
- Department of Neurological Surgery, Başkent University School of Medicine, Ankara, Turkey
| | - Carlos Torres
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Paola Torres
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Leslie Verville
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Adriaan Vlok
- Division of Neurosurgery, University of Stellenbosch, Bellville, Western Cape, South Africa
| | - William Watters
- Department of Orthopedic Weill Cornell Medical School and Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Hainan Yu
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
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26
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Issa OM, Roberts R, Mark DB, Boineau R, Goertz C, Rosenberg Y, Lewis EF, Guarneri E, Drisko J, Magaziner A, Lee KL, Lamas GA. Effect of high-dose oral multivitamins and minerals in participants not treated with statins in the randomized Trial to Assess Chelation Therapy (TACT). Am Heart J 2018; 195:70-77. [PMID: 29224648 DOI: 10.1016/j.ahj.2017.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 09/01/2017] [Indexed: 12/28/2022]
Abstract
IMPORTANCE In a prespecified subgroup analysis of participants not on statin therapy at baseline in the TACT, a high-dose complex oral multivitamins and multimineral regimen was found to have a large unexpected benefit compared with placebo. The regimen tested was substantially different from any vitamin regimen tested in prior clinical trials. OBJECTIVE To explore these results, we performed detailed additional analyses of participants not on statins at enrollment in TACT. DESIGN TACT was a factorial trial testing chelation treatments and a 28-component high-dose oral multivitamins and multiminerals regimen versus placebo in post-myocardial infarction (MI) patients 50 years or older. PARTICIPANTS There were 460 (27%) of 1,708 TACT participants not taking statins at baseline, 224 (49%) were in the active vitamin group and 236 (51%) were in the placebo group. SETTING Patients were enrolled at 134 sites around the United States and Canada. INTERVENTION Daily high-dose oral multivitamins and multiminerals (6 tablets, active or placebo). MAIN OUTCOME The primary end point of TACT was time to the first occurrence of any component of the composite end point: all-cause mortality, MI, stroke, coronary revascularization, or hospitalization for angina. RESULTS The primary end point occurred in 137 nonstatin participants (30%), of which 51 (23%) of 224 were in the active group and 86 (36%) of 236 were taking placebo (hazard ratio, 0.62; 95% confidence interval, 0.44-0.87; P=.006). Results in the key TACT secondary end point, a combination of cardiovascular mortality, stroke, or recurrent MI, was consistent in favoring the active vitamin group (hazard ratio, 0.46; 95% confidence interval, 0.28-0.75; P=.002). Multiple end point analyses were consistent with these results. CONCLUSION AND RELEVANCE High-dose oral multivitamin and multimineral supplementation seem to decrease combined cardiac events in a stable, post-MI population not taking statin therapy at baseline. These unexpected findings are being retested in the ongoing TACT2.
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Haldeman S, McAndrews GP, Goertz C, Sportelli L, Hamm AW, Johnson C. The McAndrews Leadership Lecture: February 2015, by Dr Scott Haldeman. Challenges of the Past, Challenges of the Present. J Chiropr Humanit 2015; 22:30-46. [PMID: 26770177 PMCID: PMC4685229 DOI: 10.1016/j.echu.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 09/17/2015] [Accepted: 09/20/2015] [Indexed: 05/12/2023]
Abstract
The McAndrews Leadership Lecture was developed by the American Chiropractic Association to honor the legacy of Jerome F. McAndrews, DC, and George P. McAndrews, JD, and their contributions to the chiropractic profession. This article is a transcription of the presentation made by Dr Scott Haldeman on February 28, 2015, in Washington, DC, at the National Chiropractic Leadership Conference.
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Affiliation(s)
- Scott Haldeman
- President, World Spine Care, Clinical Professor, Department of Neurology, University of California, Irvine, CA
- Adjunct Professor, Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA
| | | | - Christine Goertz
- Vice Chancellor, Research and Health Policy, Palmer College of Chiropractic and Palmer Center for Chiropractic Research, Davenport, IA
| | | | - Anthony W. Hamm
- President, American Chiropractic Association, Arlington, VA
- Private Practice, Goldsboro, NC
| | - Claire Johnson
- Professor, National University of Health Sciences, Lombard, IL
- Corresponding author at: 200 E Roosevelt Rd, Lombard, IL, 60148. Tel.: + 1 630 297 3290.200 E Roosevelt RdLombardIL60148
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Mark DB, Anstrom KJ, Clapp-Channing NE, Knight JD, Boineau R, Goertz C, Rozema TC, Liu DM, Nahin RL, Rosenberg Y, Drisko J, Lee KL, Lamas GA. Quality-of-life outcomes with a disodium EDTA chelation regimen for coronary disease: results from the trial to assess chelation therapy randomized trial. Circ Cardiovasc Qual Outcomes 2015; 7:508-16. [PMID: 24987051 DOI: 10.1161/circoutcomes.114.000977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The National Institutes of Health.funded Trial to Assess Chelation Therapy (TACT) randomized 1708 stablecoronary disease patients aged .50 years who were .6 months post.myocardial infarction (2003.2010) to 40 infusions ofa multicomponent EDTA chelation solution or placebo. Chelation reduced the primary composite end point of mortality,recurrent myocardial infarction, stroke, coronary revascularization, or hospitalization for angina (hazard ratio, 0.82; 95%confidence interval, 0.69.0.99; P=0.035). METHODS AND RESULTS In a randomly selected subset of 911 patients, we prospectively collected a battery of quality-of-life(QOL) instruments at baseline and at 6, 12, and 24 months after randomization. The prespecified primary QOL measures were the Duke Activity Status Index (Table I in the Data Supplement) and the Medical Outcomes Study Short-Form 36 Mental Health Inventory-5. All comparisons were by intention to treat. Baseline clinical and QOL variables were well balanced in the 451 patients randomized to chelation and in the 460 patients randomized to placebo. The Duke Activity Status Index improved in both groups during the first 6 months of therapy, but we found no evidence for a treatment-related difference (mean difference [chelation.placebo] during follow-up, 0.9 [95% confidence interval, .0.7 to 2.6; P=0.27]).There was no statistically significant evidence of a treatment-related difference in the Mental Health Inventory-5 during follow-up (mean difference, 1.0; 95% confidence interval, .0.1 to 2.0; P=0.08). None of the secondary QOL measures showed a consistent treatment-related difference. CONCLUSIONS In stable, predominantly asymptomatic coronary disease patients with a history of myocardial infarction,EDTA chelation therapy did not have a detectable effect on QOL during 2 years of follow-up. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov. Unique identifier: NCT00044213.
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Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, DeLitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner DK. Report of the NIH Task Force on Research Standards for Chronic Low Back Pain. Int J Ther Massage Bodywork 2015; 8:16-33. [PMID: 26388962 PMCID: PMC4560531 DOI: 10.3822/ijtmb.v8i3.295] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
UNLABELLED Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific, and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. The NIH Pain Consortium therefore charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimal data set to describe research participants (drawing heavily on the PROMIS methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect the RTF recommendations will become a dynamic document, and undergo continual improvement. PERSPECTIVE A Task Force was convened by the NIH Pain Consortium, with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimal dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.
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Affiliation(s)
| | | | | | | | | | | | | | - Roger Chou
- Oregon Health and Sciences University, Portland, OR
| | | | - Anthony DeLitto
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA
| | | | - Partap Khalsa
- National Center for Complementary and Alternative Medicine, Bethesda, MD
| | | | | | - James Panagis
- National Institute for Arthritis, Musculoskeletal and Skin Diseases, Bethesda, MD
| | | | | | | | | | - Debra K. Weiner
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA
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Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, DeLitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner DK. Report of the NIH Task Force on research standards for chronic low back pain. Pain Med 2015; 15:1249-67. [PMID: 25132307 DOI: 10.1111/pme.12538] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific, and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. DESIGN Expert panel and preliminary evaluation of key recommendations. METHODS The NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel developed a 3-stage process, each with a 2-day meeting. RESULTS The panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimal data set to describe research subjects (drawing heavily on the PROMIS methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. CONCLUSION The RTF believes these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes. We expect the RTF recommendations will become a dynamic document, and undergo continual improvement. PERSPECTIVE A task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.
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Affiliation(s)
- Richard A Deyo
- Oregon Health and Sciences University, Portland, Oregon, USA
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Basch E, Spertus J, Dudley RA, Wu A, Chuahan C, Cohen P, Smith ML, Black N, Crawford A, Christensen K, Blake K, Goertz C. Methods for Developing Patient-Reported Outcome-Based Performance Measures (PRO-PMs). Value Health 2015; 18:493-504. [PMID: 26091604 DOI: 10.1016/j.jval.2015.02.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 02/03/2015] [Accepted: 02/15/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To recommend methods for assessing quality of care via patient-reported outcome-based performance measures (PRO-PMs) of symptoms, functional status, and quality of life. METHODS A Technical Expert Panel was assembled by the American Medical Association-convened Physician Consortium for Performance Improvement. An environmental scan and structured literature review were conducted to identify quality programs that integrate PRO-PMs. Key methodological considerations in the design, implementation, and analysis of these PRO-PM data were systematically identified. Recommended methods for addressing each identified consideration were developed on the basis of published patient-reported outcome (PRO) standards and refined through public comment. Literature review focused on programs using PROs to assess performance and on PRO guidance documents. RESULTS Thirteen PRO programs and 10 guidance documents were identified. Nine best practices were developed, including the following: provide a rationale for measuring the outcome and for using a PRO-PM; describe the context of use; select a measure that is meaningful to patients with adequate psychometric properties; provide evidence of the measure's sensitivity to differences in care; address missing data and risk adjustment; and provide a framework for implementation, interpretation, dissemination, and continuous refinement. CONCLUSION Methods for integrating PROs into performance measurement are available.
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Affiliation(s)
- Ethan Basch
- University of North Carolina, Chapel Hill, NC, USA.
| | | | - R Adams Dudley
- University of California, San Francisco, San Francisco, CA, USA
| | - Albert Wu
- Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Perry Cohen
- Parkinson Pipeline Project, Washington, DC (Patient Representative), USA
| | - Mary Lou Smith
- Research Advocacy Network, Plano, TX (Patient Representative), USA
| | - Nick Black
- London School of Hygiene and Tropical Medicine, London, England
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Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, Delitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner DK. Report of the NIH Task Force on research standards for chronic low back pain. Phys Ther 2015; 95:e1-e18. [PMID: 25639530 PMCID: PMC5396149 DOI: 10.2522/ptj.2015.95.2.e1] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement. PERSPECTIVE A task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.
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Affiliation(s)
- Richard A Deyo
- R.A. Deyo, MD, MPH, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Mail Code FM, Portland, Oregon.
| | | | | | | | | | | | - John Carrino
- J. Carrino, Johns Hopkins University, Baltimore, Maryland
| | - Roger Chou
- R. Chou, Oregon Health and Sciences University
| | - Karon Cook
- K. Cook, Northwestern University, Evanston, Illinois
| | - Anthony Delitto
- A. Delitto, VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Partap Khalsa
- P. Khalsa, National Center for Complementary and Alternative Medicine, Bethesda, Maryland
| | | | | | - James Panagis
- J. Panagis, National Institute for Arthritis, Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - James Rainville
- J. Rainville, New England Baptist Hospital, Roxbury Crossing, Massachusetts
| | - Tor Tosteson
- T. Tosteson, Dartmouth University, Hanover, New Hampshire
| | | | | | - Debra K Weiner
- D.K. Weiner, VA Pittsburgh Healthcare System and University of Pittsburgh
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Vining RD, Potocki E, McLean I, Seidman M, Morgenthal AP, Boysen J, Goertz C. Prevalence of radiographic findings in individuals with chronic low back pain screened for a randomized controlled trial: secondary analysis and clinical implications. J Manipulative Physiol Ther 2014; 37:678-87. [PMID: 25455834 DOI: 10.1016/j.jmpt.2014.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 08/16/2014] [Accepted: 09/01/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study is to measure the prevalence of graded disc degeneration, spondylolisthesis, transitional segmentation, and the distribution of sacral slope in patients 21 to 65 years of age with chronic low back pain (CLBP). METHODS This retrospective study analyzed 247 digital lumbar radiographic series obtained during a randomized controlled trial of chiropractic patients with CLBP. Chronic low back pain was defined as pain in the low back lasting 12 weeks or longer. Radiographic findings of disc degeneration, spondylolisthesis, and lumbosacral transitional segmentation were graded by 2 authors using established classification criteria. Sacral slope was measured with a digital tool contained within imaging software. RESULTS Lumbosacral transitional segments graded I to IV (Castellvi classification) were present in 14% of cases. Lumbar disc degeneration was most prevalent at L3-4 (49%), followed by L4-5 (42%), L2-3 (41%), L5-S1 (37%), and L1-2 (29%). Isthmic spondylolisthesis was present in 5% of cases, with L5 the most common location. Degenerative spondylolisthesis demonstrated a prevalence of 18%, most commonly occurring at L4. The prevalence of degenerative spondylolisthesis was 51% for women aged 50 to 59 years and 24% for men in the same age range. CONCLUSIONS Moderate-severe disc degeneration, multilevel disc narrowing, and degenerative spondylolisthesis were common in individuals with CLBP with age more than 40 years. Isthmic spondylolisthesis was not more prevalent than what has been reported in other populations. Transitional segmentation was identified in a minority of participants, with some of these exhibiting accessory joints or fusion. Mean sacral slope in individuals with CLBP was not substantially different from mean slopes reported in other populations.
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Affiliation(s)
- Robert D Vining
- Associate Professor, Senior Research Clinician, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
| | - Eric Potocki
- Research Clinician, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - Ian McLean
- Professor, Director of Clinical Radiology, Palmer College of Chiropractic, Davenport, IA
| | - Michael Seidman
- Research Clinician, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - A Paige Morgenthal
- Research Clinician, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - James Boysen
- Study Coordinator, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - Christine Goertz
- Vice Chancellor for Research and Health Policy, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
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Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, DeLitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner DK. Report of the National Institutes of Health task force on research standards for chronic low back pain. J Manipulative Physiol Ther 2014; 37:449-67. [PMID: 25127996 DOI: 10.1016/j.jmpt.2014.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/08/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed nonspecific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. The purpose of this article is to disseminate the report of the National Institutes of Health (NIH) task force on research standards for cLBP. METHODS The NIH Pain Consortium charged a research task force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel developed a 3-stage process, each with a 2-day meeting. RESULTS The panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimal data set to describe research subjects (drawing heavily on the Patient Reported Outcomes Measurement Information System methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved these recommendations, which investigators should incorporate into NIH grant proposals. CONCLUSIONS The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of cLBP. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes. We expect the RTF recommendations will become a dynamic document and undergo continual improvement.
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Affiliation(s)
- Richard A Deyo
- Professor, Department of Family Medicine, Oregon Health & Science University, Portland, OR; Professor, Department of Medicine, Oregon Health & Science University, Portland, OR; Professor, Department of Public Health & Community Medicine, Oregon Health & Science University, Portland, OR.
| | - Samuel F Dworkin
- Professor, Department of Oral Medicine, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Dagmar Amtmann
- Research Associate Professor, Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Gunnar Andersson
- Professor, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - David Borenstein
- Clinical Professor, Department of Medicine, George Washington University Medical Center, Washington, DC
| | - Eugene Carragee
- Professor, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - John Carrino
- Associate Professor, Department of Radiology, Johns Hopkins University, Baltimore, MD
| | - Roger Chou
- Professor, Department of Medicine, Oregon Health and Science University, Portland, OR; Professor, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR
| | - Karon Cook
- Research Associate Professor, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anthony DeLitto
- Professor, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Christine Goertz
- Vice Chancellor of Research & Health Policy, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - Partap Khalsa
- Deputy Director, National Institutes of Health, Division of Extramural Research, National Center for Complementary and Alternative Medicine, Bethesda, MD
| | - John Loeser
- Professor Emeritus, Department of Neurological Surgery, University of Washington, Seattle, WA; Professor Emeritus, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Sean Mackey
- Professor, Department of Anesthesia and Pain Management, Stanford University, Stanford, CA
| | - James Panagis
- Program Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Orthopaedics Research Program, Bethesda, MD
| | - James Rainville
- Chief, Department of Physical Medicine and Rehabilitation, New England Baptist Hospital, Roxbury Crossing, MA
| | - Tor Tosteson
- Professor, Department of Community and Family Medicine and The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Dennis Turk
- Professor Emeritus, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | | | - Debra K Weiner
- Professor, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Professor, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA; Professor, Department of Anesthesiology; University of Pittsburgh, Pittsburgh, PA. Geriatric Research, Educational and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
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Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, DeLitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner DK. Report of the NIH Task Force on research standards for chronic low back pain. J Pain 2014; 15:569-85. [PMID: 24787228 PMCID: PMC4128347 DOI: 10.1016/j.jpain.2014.03.005] [Citation(s) in RCA: 278] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/24/2014] [Accepted: 03/12/2014] [Indexed: 12/18/2022]
Abstract
UNLABELLED Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement. PERSPECTIVE A task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.
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Affiliation(s)
- Richard A Deyo
- Oregon Health and Sciences University, Portland, Oregon.
| | | | | | | | | | | | | | - Roger Chou
- Oregon Health and Sciences University, Portland, Oregon
| | - Karon Cook
- Northwestern University, Evanston, Illinois
| | - Anthony DeLitto
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Partap Khalsa
- National Center for Complementary and Alternative Medicine, Bethesda, Maryland
| | - John Loeser
- University of Washington, Seattle, Washington
| | | | - James Panagis
- National Institute for Arthritis, Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - James Rainville
- New England Baptist Hospital, Roxbury Crossing, Massachusetts
| | | | - Dennis Turk
- University of Washington, Seattle, Washington
| | | | - Debra K Weiner
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania
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Lamas GA, Goertz C, Boineau R, Mark DB, Rozema T, Nahin RL, Lindblad L, Lewis EF, Drisko J, Lee KL. Disodium EDTA Chelation for Post Myocardial Infarction Patients. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5001.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gervasio A. Lamas
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (3) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Christine Goertz
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (3) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Robin Boineau
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (3) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Daniel B. Mark
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (3) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Theodore Rozema
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (3) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Richard L. Nahin
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (3) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Lauren Lindblad
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (3) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Eldrin F. Lewis
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (3) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Jeanne Drisko
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (3) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Kerry L. Lee
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (3) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
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Goertz C, Long C, Vining R, Salsbury S, Pohlman K, Lamas G. Chiropractic for Hypertension in Patients (CHiP): A Pilot Randomized Controlled Trial. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5003.abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christine Goertz
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) University of Alberta, Edmonton, AB, Canada
- (3) Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Cynthia Long
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) University of Alberta, Edmonton, AB, Canada
- (3) Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Robert Vining
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) University of Alberta, Edmonton, AB, Canada
- (3) Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Stacie Salsbury
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) University of Alberta, Edmonton, AB, Canada
- (3) Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Katherine Pohlman
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) University of Alberta, Edmonton, AB, Canada
- (3) Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Gervasio Lamas
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) University of Alberta, Edmonton, AB, Canada
- (3) Mount Sinai Medical Center, Miami Beach, FL, USA
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Lamas GA, Boineau R, Goertz C, Mark DB, Rosenberg Y, Stylianou M, Rozema T, Nahin RL, Lindblad L, Lewis EF, Drisko J, Lee KL. Oral High-Dose Multivitamins and Minerals Alone and in Combination with Chelation Therapy for Coronary Disease: A Randomized Clinical Trial. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5002.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gervasio A. Lamas
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (3) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Robin Boineau
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (3) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Christine Goertz
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (3) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Daniel B. Mark
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (3) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Yves Rosenberg
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (3) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Mario Stylianou
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (3) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Theodore Rozema
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (3) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Richard L. Nahin
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (3) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Lauren Lindblad
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (3) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Eldrin F. Lewis
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (3) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Jeanne Drisko
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (3) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
| | - Kerry L. Lee
- (1) Mount Sinai Medical Center, Miami Beach, FL, USA
- (2) National Heart, Lung and Blood Institute, Bethesda, MD, USA
- (3) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (4) Duke Clinical Research Institute, Durham, NC, USA
- (5) Biogenesis Medical Center, Landrum, SC, USA
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Ouyang P, Lamas G, Nahin R, Gallup D, Boineau R, Rosenberg Y, Mark D, Goertz C, Lee K. EFFECT OF CHELATION THERAPY ON CARDIOVASCULAR EVENTS BY CHRONIC KIDNEY DISEASE STAGE: DATA FROM THE TRIAL TO ASSESS CHELATION THERAPY (TACT). J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61540-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lamas GA, Boineau R, Goertz C, Mark DB, Rosenberg Y, Stylianou M, Rozema T, Nahin RL, Lindblad L, Lewis EF, Drisko J, Lee KL. Oral high-dose multivitamins and minerals after myocardial infarction: a randomized trial. Ann Intern Med 2013; 159:797-805. [PMID: 24490264 PMCID: PMC4143134 DOI: 10.7326/0003-4819-159-12-201312170-00004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Whether high-dose multivitamins are effective for secondary prevention of atherosclerotic disease is unknown. OBJECTIVE To assess whether oral multivitamins reduce cardiovascular events and are safe. DESIGN Double-blind, placebo-controlled, 2 x 2 factorial, multicenter, randomized trial. (ClinicalTrials.gov: NCT00044213) SETTING: 134 U.S. and Canadian academic and clinical sites. PATIENTS 1708 patients aged 50 years or older who had myocardial infarction (MI) at least 6 weeks earlier and had serum creatinine levels of 176.8 mol/L (2.0 mg/dL) or less. INTERVENTION Patients were randomly assigned to an oral, 28-component, high-dose multivitamin and multimineral mixture or placebo. MEASUREMENTS The primary end point was time to total death, recurrent MI, stroke, coronary revascularization, or hospitalization for angina. RESULTS The median age was 65 years, and 18% of patients were women. The qualifying MI occurred a median of 4.6 years (interquartile range [IQR], 1.6 to 9.2 years) before enrollment. Median follow-up was 55 months (IQR, 26 to 60 months). Patients received vitamins for a median of 31 months (IQR, 13 to 59 months) in the vitamin group and 35 months (IQR, 13 to 60 months) in the placebo group (P = 0.65). Totals of 645 (76%) and 646 (76%) patients in the vitamin and placebo groups, respectively, completed at least 1 year of oral therapy (P = 0.98), and 400 (47%) and 426 (50%) patients, respectively, completed at least 3 years (P = 0.23). Totals of 394 (46%) and 390 (46%) patients in the vitamin and placebo groups, respectively, discontinued the vitamin regimen (P = 0.67), and 17% of patients withdrew from the study. The primary end point occurred in 230 (27%) patients in the vitamin group and 253 (30%) in the placebo group (hazard ratio, 0.89 [95% CI, 0.75 to 1.07]; P = 0.21). No evidence suggested harm from vitamin therapy in any category of adverse events. LIMITATION There was considerable nonadherence and withdrawal, limiting the ability to draw firm conclusions (particularly about safety). CONCLUSION High-dose oral multivitamins and multiminerals did not statistically significantly reduce cardiovascular events in patients after MI who received standard medications. However, this conclusion is tempered by the nonadherence rate. PRIMARY FUNDING SOURCE National Institutes of Health.
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Escolar E, Lamas GA, Mark DB, Boineau R, Goertz C, Rosenberg Y, Nahin RL, Ouyang P, Rozema T, Magaziner A, Nahas R, Lewis EF, Lindblad L, Lee KL. The effect of an EDTA-based chelation regimen on patients with diabetes mellitus and prior myocardial infarction in the Trial to Assess Chelation Therapy (TACT). Circ Cardiovasc Qual Outcomes 2013; 7:15-24. [PMID: 24254885 DOI: 10.1161/circoutcomes.113.000663] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The Trial to Assess Chelation Therapy (TACT) showed clinical benefit of an EDTA-based infusion regimen in patients aged ≥50 years with prior myocardial infarction. Diabetes mellitus before enrollment was a prespecified subgroup. METHODS AND RESULTS Patients received 40 infusions of EDTA chelation or placebo. A total of 633 (37%) patients had diabetes mellitus (322 EDTA and 311 placebo). EDTA reduced the primary end point (death, reinfarction, stroke, coronary revascularization, or hospitalization for angina; 25% versus 38%; hazard ratio, 0.59; 95% confidence interval [CI], 0.44-0.79; P<0.001) over 5 years. The result remained significant after Bonferroni adjustment for multiple subgroups (99.4% CI, 0.39-0.88; adjusted P=0.002). All-cause mortality was reduced by EDTA chelation (10% versus 16%; hazard ratio, 0.57; 95% CI, 0.36-0.88; P=0.011), as was the secondary end point (cardiovascular death, reinfarction, or stroke; 11% versus 17%; hazard ratio, 0.60; 95% CI, 0.39-0.91; P=0.017). However, after adjusting for multiple subgroups, those results were no longer significant. The number needed to treat to reduce 1 primary end point over 5 years was 6.5 (95% CI, 4.4-12.7). There was no reduction in events in non-diabetes mellitus (n=1075; P=0.877), resulting in a treatment by diabetes mellitus interaction (P=0.004). CONCLUSIONS Post-myocardial infarction patients with diabetes mellitus aged ≥50 demonstrated a marked reduction in cardiovascular events with EDTA chelation. These findings support efforts to replicate these findings and define the mechanisms of benefit. However, they do not constitute sufficient evidence to indicate the routine use of chelation therapy for all post-myocardial infarction patients with diabetes mellitus. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00044213.
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Affiliation(s)
- Esteban Escolar
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL
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Lamas GA, Goertz C, Boineau R, Mark DB, Rozema T, Nahin RL, Lindblad L, Lewis EF, Drisko J, Lee KL. Effect of disodium EDTA chelation regimen on cardiovascular events in patients with previous myocardial infarction: the TACT randomized trial. JAMA 2013; 309:1241-50. [PMID: 23532240 PMCID: PMC4066975 DOI: 10.1001/jama.2013.2107] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Chelation therapy with disodium EDTA has been used for more than 50 years to treat atherosclerosis without proof of efficacy. OBJECTIVE To determine if an EDTA-based chelation regimen reduces cardiovascular events. DESIGN, SETTING, AND PARTICIPANTS Double-blind, placebo-controlled, 2 × 2 factorial randomized trial enrolling 1708 patients aged 50 years or older who had experienced a myocardial infarction (MI) at least 6 weeks prior and had serum creatinine levels of 2.0 mg/dL or less. Participants were recruited at 134 US and Canadian sites. Enrollment began in September 2003 and follow-up took place until October 2011 (median, 55 months). Two hundred eighty-nine patients (17% of total; n=115 in the EDTA group and n=174 in the placebo group) withdrew consent during the trial. INTERVENTIONS Patients were randomized to receive 40 infusions of a 500-mL chelation solution (3 g of disodium EDTA, 7 g of ascorbate, B vitamins, electrolytes, procaine, and heparin) (n=839) vs placebo (n=869) and an oral vitamin-mineral regimen vs an oral placebo. Infusions were administered weekly for 30 weeks, followed by 10 infusions 2 to 8 weeks apart. Fifteen percent discontinued infusions (n=38 [16%] in the chelation group and n=41 [15%] in the placebo group) because of adverse events. MAIN OUTCOME MEASURES The prespecified primary end point was a composite of total mortality, recurrent MI, stroke, coronary revascularization, or hospitalization for angina. This report describes the intention-to-treat comparison of EDTA chelation vs placebo. To account for multiple interim analyses, the significance threshold required at the final analysis was P = .036. RESULTS Qualifying previous MIs occurred a median of 4.6 years before enrollment. Median age was 65 years, 18% were female, 9% were nonwhite, and 31% were diabetic. The primary end point occurred in 222 (26%) of the chelation group and 261 (30%) of the placebo group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.99]; P = .035). There was no effect on total mortality (chelation: 87 deaths [10%]; placebo, 93 deaths [11%]; HR, 0.93 [95% CI, 0.70-1.25]; P = .64), but the study was not powered for this comparison. The effect of EDTA chelation on the components of the primary end point other than death was of similar magnitude as its overall effect (MI: chelation, 6%; placebo, 8%; HR, 0.77 [95% CI, 0.54-1.11]; stroke: chelation, 1.2%; placebo, 1.5%; HR, 0.77 [95% CI, 0.34-1.76]; coronary revascularization: chelation, 15%; placebo, 18%; HR, 0.81 [95% CI, 0.64-1.02]; hospitalization for angina: chelation, 1.6%; placebo, 2.1%; HR, 0.72 [95% CI, 0.35-1.47]). Sensitivity analyses examining the effect of patient dropout and treatment adherence did not alter the results. CONCLUSIONS AND RELEVANCE Among stable patients with a history of MI, use of an intravenous chelation regimen with disodium EDTA, compared with placebo, modestly reduced the risk of adverse cardiovascular outcomes, many of which were revascularization procedures. These results provide evidence to guide further research but are not sufficient to support the routine use of chelation therapy for treatment of patients who have had an MI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00044213.
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Affiliation(s)
- Gervasio A Lamas
- Columbia University Division of Cardiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140, USA.
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Goertz C, Marriott BP, Finch MD, Bray RM, Williams TV, Hourani LL, Hadden LS, Colleran HL, Jonas WB. Military report more complementary and alternative medicine use than civilians. J Altern Complement Med 2013; 19:509-17. [PMID: 23323682 DOI: 10.1089/acm.2012.0108] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The study objective was to estimate complementary and alternative medicine (CAM) use among active duty military and compare data with civilian use. DESIGN A global survey on CAM use in the 12 previous months was conducted. Final participants (16,146) were stratified by gender, service, region, and pay grade. Analysis included prevalence of CAM use, demographic and lifestyle characteristics. RESULTS Approximately 45% of respondents reported using at least one type of CAM therapy. Most commonly used therapies were as follows: prayer for one's own health (24.4%), massage therapy (14.1%), and relaxation techniques (10.8%). After exclusion of prayer for one's own health, adjusting to the 2000 U.S. census, overall CAM use in the military (44.5%) was higher than that in comparable civilian surveys (36.0% and 38.3%). CONCLUSIONS Military personnel reported using three CAM stress-reduction therapies at 2.5-7 times the rate of civilians. Among the military, high utilization of CAM practices that reduce stress may serve as markers for practitioners assessing an individual's health and well-being.
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Basch EM, Goertz C, Christenson K, Crawford A, Dudley RA, Spertus J. Standards for evaluating patient-reported outcome (PRO)-based performance measures. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.34_suppl.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
45 Background: There is growing interest to use performance measures that integrate patient-reported outcomes (PROs), but there are no existing methodological standards for developing, implementing, or analyzing such measures in this context. Methods: To develop standards for evaluating PRO-based performance measures submitted to or developed by the American Medical Association-convened Physician Consortium for Performance Improvement, a multi-disciplinary expert technical panel was assembled. A systematic literature review and landscape overview were conducted to identify use cases and existing PRO standards in related contexts. Lessons learned from use cases and existing standards guided development of discrete methodological standards. Results: The systematic review identified only one use case, whereas the landscape overview identified eight. Five purposes were identified for which PROs might be measured to assess performance, including one categorized as process and four as outcome. Eight discrete methodological standards were developed which will be detailed at the meeting. Conclusions: The patient perspective is an essential but missing component of performance evaluation. When appropriately elicited, data from patients can be informative. Lack of adherence to good practices and inadequate patient input when developing measurement strategies are potential pitfalls to be avoided.
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Affiliation(s)
| | | | | | | | | | - John Spertus
- University of Missouri-Kansas City, Kansas City, MO
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Pohlman K, Carber L, Vining R, Devlin T, Rice R, Salsbury S, Corber L, Hondras M, Long C, Goertz C. P02.39. Leveraging grant awards to enhance the research infrastructure at a CAM institution. Altern Ther Health Med 2012. [PMCID: PMC3373852 DOI: 10.1186/1472-6882-12-s1-p95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goertz C, Long C, Hondras M, Petri R, Meeker W, Lawrence D, Owens E. P02.126. Addition of chiropractic manipulative therapy to standard medical care may improve outcomes for acute low back pain in active-duty military personnel. BMC Complement Altern Med 2012. [PMCID: PMC3373690 DOI: 10.1186/1472-6882-12-s1-p182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lyons K, Salsbury S, Hondras M, Jones M, Andresen A, Goertz C. P05.59. Older adults’ attitudes on collaborative care of low back pain by doctors of chiropractic and medical doctors: a focus group study. BMC Complement Altern Med 2012. [PMCID: PMC3373823 DOI: 10.1186/1472-6882-12-s1-p419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Goertz C, Salsbury S, Vining R, Andresen A, Hondras M, Jones M, Killinger L, Long C, Lyons K, Wallace R. P03.09. Development of an interprofessional model of collaborative care by doctors of chiropractic and medical doctors for older adults with low back pain. Altern Ther Health Med 2012. [PMCID: PMC3373706 DOI: 10.1186/1472-6882-12-s1-p262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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DeVocht J, Salsbury S, Seidman M, Carber L, Schaeffer W, Stanford C, Goertz C, Spector M, Hondras M. P02.90. Equivalence of doctor interactions between Activator Methods and sham chiropractic protocols during an expertise-based randomized clinical trial. Altern Ther Health Med 2012. [PMCID: PMC3373679 DOI: 10.1186/1472-6882-12-s1-p146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lamas GA, Goertz C, Boineau R, Mark DB, Rozema T, Nahin RL, Drisko JA, Lee KL. Design of the Trial to Assess Chelation Therapy (TACT). Am Heart J 2012; 163:7-12. [PMID: 22172430 DOI: 10.1016/j.ahj.2011.10.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 10/04/2011] [Indexed: 12/31/2022]
Abstract
TACT is an National Institutes of Health-sponsored, randomized, double-blind, placebo-controlled, 2 × 2 factorial clinical trial testing the benefits and risks of 40 infusions of a multicomponent disodium EDTA chelation solution compared with placebo and of an oral, high-dose multivitamin and mineral supplement. TACT has randomized and will follow up 1,708 patients for an average of approximately 4 years. The primary end point is a composite of all-cause mortality, myocardial infarction, stroke, coronary revascularization, and hospitalization for angina. A 900-patient substudy will examine quality-of-life outcomes. The trial is designed to have >85% power to detect a 25% relative reduction in the primary end point for each treatment factor. Enrollment began in September 2003 and was completed in October 2010.
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