Specifically designed control interventions can account for expectation effects in clinical trials. For the interpretation of efficacy trials of physical, psychological, and self-management interventions for people living with pain, the design, conduct, and reporting of control interventions is crucial. To establish a quality standard in the field, core recommendations are presented alongside additional considerations and a reporting checklist for control interventions.Background
Objectives
Strengthening the lumbar extensor musculature is a common recommendation for CLBP. Although reported as effective, variability in response in CLBP populations is not well investigated. This study investigated variability in responsiveness to isolated lumbar extension (ILEX) resistance training in CLBP participants by retrospective analysis of 3 RCTS. Data from 77 intervention participants was available (males = 43, females = 34) 37 control participants (males = 20, females = 17). Intervention participants all underwent 12wks of ILEX resistance training and changes in ILEX strength, pain (VAS) and disability (ODI) measured. True inter-individual response variability was examined through calculation of difference in the standard deviation of change scores for both control and intervention. Intervention participants were classified into using Purpose and Background
Methods and Results
Low Back Pain and Neck Pain rank 1 and 4 on the causes of years lost to disability (YLDs) in the UK. Treatment options are broad including popular approaches such as chiropractic care but with NHS funding limited to recent initiatives such as Any Qualified Provider (AQP). Eleven chiropractic practices with AQP contracts took part in the study. As part of routine clinical practice, patients are entered onto a web based patient reported outcome system that sends automated e mails links to questionnaires, prior to the initial visit (includes the Bournemouth Questionnaire (BQ) and STarT Back, and at 14, 30 and 90 days (BQ and Patient Global Impression of Change (PGIC)). Data from subjects consenting for such use were used in the analysis.Background:
Method:
Retrospective review of seventeen consecutive survivors of craniocervical dissociation (CCD). Thirteen patients had delay in diagnosis, with associated neurologic deterioration in five. Diagnosis of CCD was entertained after lateral C-spine x-ray in only two patients, and after screening C-spine CT in two others. At fifteen-month average follow-up, mean ASIA motor score improved from fifty preoperatively to seventy-nine postoperatively. One patient had temporary postoperative neurologic decline. There were no pseudarthroses. The diagnosis of CCD is often missed, with potentially severe neurologic consequences. Early diagnosis and stabilization are neuroprotective. A classification that identifies minimally displaced yet unstable injuries may improve diagnostic accuracy. To identify the timing and method of diagnosis, diagnostic reliability of screening lateral radiographs, effect of delayed diagnosis, complications of treatment, and neurologic outcome of this life-threatening condition. Diagnosis of craniocervical dissociation (CCD) was frequently delayed, increasing the risk of neurologic decline. Early diagnosis and stabilization protected against worsening spinal cord injury. This study highlights the importance of disciplined evaluation of the lateral cervical spine radiograph of poly-traumatized patients. Head-injured patients with cranio-facial trauma and asymmetric high cervical spinal cord injuries should heighten clinicians’ suspicion of CCD. CCD was identified or suspected on two of seventeen (12%) initial lateral cervical spine radiographs, and on screening CT scan in only two additional patients (12%), despite an abnormal dens-basion relationship in 16/17 (94%) patients. Of the thirteen patients with (two-day average) delay in diagnosis, 5/13 (38%) had profound neurologic deterioration. One patient worsened temporarily after fixation. There were no pseudarthroses at fifteen-month average follow-up. Mean ASIA motor score of fifty improved to seventy-nine, and the number of patients with useful motor function (ASIA D or E) increased from seven (41%) preoperatively to thirteen (76%) postoperatively. Four patients with severe craniocervical instability had <
3 mm displacement. We therefore adopted a classification based on provocative traction testing of minimally displaced injuries.(Table). Retrospective review of seventeen consecutive CCD survivors identified between 1994–2002 through institutional databases. Radiographic and clinical results were evaluated, emphasizing timing of diagnosis, effect of delayed diagnosis, clinical or radiographic warning signs, and response to treatment. Please contact author for tables and /or diagrams.
