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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 14 - 14
1 Oct 2022
THE CLINICAL AND COST-EFFECTIVENESS OF A PHYSIOTHERAPY-DELIVERED PHYSICAL AND PSYCHOLOGICAL GROUP INTERVENTION FOR OLDER ADULTS WITH NEUROGENIC CLAUDICATION: THE BOOST RANDOMIZED CONTROLLED TRIAL
Williamson E Boniface G Marian I Dutton S Maredza M Petrou S Garrett A Morris A Hansen Z Ward L Nicolson P Barker K Fairbank J Fitch J Rogers D Comer C French D Mallen C Lamb S
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Purpose and background

To evaluate the clinical and cost-effectiveness of a physical and psychological group intervention (BOOST programme) compared to physiotherapy assessment and advice (best practice advice [BPA]) for older adults with neurogenic claudication (NC) which is a debilitating spinal condition.

Methods and results

A randomised controlled trial of 438 participants. The primary outcome was the Oswestry Disability Index (ODI) at 12 months. Data was also collected at 6 months. Other outcomes included Swiss Spinal Stenosis Questionnaire (symptoms), ODI walking item, 6-minute walk test (6MWT) and falls. The analysis was intention-to-treat. We collected the EQ5D and health and social care use to estimate cost-effectiveness.

Participants were, on average, 74.9 years old (SD 6.0). There was no significant difference in ODI scores between groups at 12 months (adjusted mean difference (MD): −1.4 [95% Confidence Intervals (CI) −4.03,1.17]), but, at 6 months, ODI scores favoured the BOOST programme (adjusted MD: −3.7 [95% CI −6.27, −1.06]). Symptoms followed a similar pattern. The BOOST programme resulted in greater improvements in walking capacity (6MWT MD 21.7m [95% CI 5.96, 37.38]) and ODI walking item (MD −0.2 [95% CI −0.45, −0.01]) and reduced falls risk (odds ratio 0.6 [95% CI 0.40, 0.98]) compared to BPA at 12 months. Probability that the BOOST programme is cost-effective ranged from 67%–89% across cost-effectiveness thresholds.

Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_II | Pages 209 - 209
1 Apr 2005
WHAT IS A MINIMALLY IMPORTANT DIFFERENCE IN OUTCOME: EVIDENCE FROM THE UK BEAM TRIAL
Garrett A Underwood M
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Background and Significance. The minimally important difference (MID) in outcome, at an individual patient or population level, is crucial to interpreting the outcome of randomised controlled trials (RCTs). We have used the UK BEAM dataset to define a minimally important difference in outcome for the Roland Morris Disability Questionnaire (RMDQ) for different baseline values of the RMDQ.

Method and Results: . We recruited 1,334 participants to UK BEAM. In addition to the RMDQ we included a specific health transition question on satisfaction with current health state that consists of a five point ordinal scale.. We used mean changes and ROC curves to identify the whole number of points change in RMDQ that represented a MID, defined as an improvement of one category on the satisfaction scale, using six bands of baseline RMDQ score 4–24, 4–7, 5–12, 9–16, 13–20 & 17–24, three months after randomization. Rounding up our data give values for the MID, for improvement, in each of these groups of 2,1,2,4,4,6 respectively

Conclusions: The MID, to an individual, is different at different baseline values of RMDQ. Interpretation of MID at high baseline values is difficult because of small numbers. Because of difference in methodological approach our analysis has produced smaller values than the previous study of MID. However, different values for MID should be used at different levels of baseline severity. The use of this approach would allow the number of individual gaining at least a minimally important benefit (or harm) from interventions tested in randomised controlled trials.