wow-inequalities/02-data/intermediate/wos_sample/a85ba518af76aa8245b354e02395d75d-darlow-ben-and-stan/info.yaml

183 lines
5.7 KiB
YAML
Raw Normal View History

2023-09-28 14:46:10 +00:00
abstract: 'Background
Effective and cost-effective primary care treatments for low back pain
(LBP) are required to reduce the burden of the world''s most disabling
condition. This study aimed to compare the clinical effectiveness and
cost-effectiveness of the Fear Reduction Exercised Early (FREE) approach
to LBP (intervention) with usual general practitioner (GP) care
(control).
Methods and findings
This pragmatic, cluster-randomised controlled trial with process
evaluation and parallel economic evaluation was conducted in the Hutt
Valley, New Zealand. Eight general practices were randomly assigned
(stratified by practice size) with a 1:1 ratio to intervention (4
practices; 34 GPs) or control group (4 practices; 29 GPs). Adults
presenting to these GPs with LBP as their primary complaint were
recruited. GPs in the intervention practices were trained in the FREE
approach, and patients presenting to these practices received care based
on the FREE approach. The FREE approach restructures LBP consultations
to prioritise early identification and management of barriers to
recovery. GPs in control practices did not receive specific training for
this study, and patients presenting to these practices received usual
care. Between 23 September 2016 and 31 July 2017, 140 eligible patients
presented to intervention practices (126 enrolled) and 110 eligible
patients presented to control practices (100 enrolled). Patient mean age
was 46.1 years (SD 14.4), and 46\% were female. The duration of LBP was
less than 6 weeks in 88\% of patients. Primary outcome was change from
baseline in patient participant Roland Morris Disability Questionnaire
(RMDQ) score at 6 months. Secondary patient outcomes included pain,
satisfaction, and psychosocial indices. GP outcomes included attitudes,
knowledge, confidence, and GP LBP management behaviour. There was active
and passive surveillance of potential harms. Patients and outcome
assessors were blind to group assignment. Analysis followed
intention-to-treat principles. A total of 122 (97\%) patients from 32
GPs in the intervention group and 99 (99\%) patients from 25 GPs in the
control group were included in the primary outcome analysis. At 6
months, the groups did not significantly differ on the primary outcome
(adjusted mean RMDQ score difference 0.57, 95\% CI - 0.64 to 1.78; p =
0.354) or secondary patient outcomes. The RMDQ difference met the
predefined criterion to indicate noninferiority. One control group
participant experienced an activity-related gluteal tear, with no other
adverse events recorded. Intervention group GPs had improvements in
attitudes, knowledge, and confidence compared with control group GPs.
Intervention group GP LBP management behaviour became more guideline
concordant than the control group. In cost-effectiveness, the
intervention dominated control with lower costs and higher
QualityAdjusted Life Year (QALY) gains. Limitations of this study were
that although adequately powered for primary outcome assessment, the
study was not powered for evaluating some employment, healthcare use,
and economic outcomes. It was also not possible for research nurses
(responsible for patient recruitment) to be masked on group allocation
for practices.
Conclusions
Findings from this study suggest that the FREE approach improves GP
concordance with LBP guideline recommendations but does not improve
patient recovery outcomes compared with usual care. The FREE approach
may reduce unnecessary healthcare use and produce economic benefits.
Work participation or health resource use should be considered for
primary outcome assessment in future trials of undifferentiated LBP.'
affiliation: 'Darlow, B (Corresponding Author), Univ Otago, Dept Primary Hlth Care
\& Gen Practice, Wellington, New Zealand.
Darlow, Ben; Garrett, Sue; Dowell, Anthony, Univ Otago, Dept Primary Hlth Care \&
Gen Practice, Wellington, New Zealand.
Stanley, James, Univ Otago, Biostat Grp, Wellington, New Zealand.
Dean, Sarah, Univ Exeter, Med Sch, Coll Med \& Hlth, Exeter, Devon, England.
Abbott, J. Haxby; Wilson, Ross, Univ Otago, Dept Surg Sci, Dunedin, New Zealand.
Mathieson, Fiona, Univ Otago, Dept Psychol Med, Wellington, New Zealand.'
article-number: e1002897
author: Darlow, Ben and Stanley, James and Dean, Sarah and Abbott, J. Haxby and Garrett,
Sue and Wilson, Ross and Mathieson, Fiona and Dowell, Anthony
author-email: ben.darlow@otago.ac.nz
author_list:
- family: Darlow
given: Ben
- family: Stanley
given: James
- family: Dean
given: Sarah
- family: Abbott
given: J. Haxby
- family: Garrett
given: Sue
- family: Wilson
given: Ross
- family: Mathieson
given: Fiona
- family: Dowell
given: Anthony
da: '2023-09-28'
doi: 10.1371/journal.pmed.1002897
eissn: 1549-1676
files: []
issn: 1549-1277
journal: PLOS MEDICINE
keywords-plus: MULTIPLE IMPUTATION
language: English
month: SEP
number: '9'
number-of-cited-references: '35'
orcid-numbers: 'Abbott, J. Haxby/0000-0001-6468-7284
Wilson, Ross/0000-0001-8505-8081
Dean, Sarah/0000-0002-3682-5149
Darlow, Ben/0000-0002-6248-6814'
papis_id: 23b1c64f7c7488c24ffdee7dfb3b113f
ref: Darlow2019fearreduction
researcherid-numbers: 'Abbott, J. Haxby/AAK-4346-2020
Wilson, Ross/AAH-3161-2019
Darlow, Ben/N-9905-2013'
times-cited: '16'
title: 'The Fear Reduction Exercised Early (FREE) approach to management of low back
pain in general practice: A pragmatic cluster-randomised controlled trial'
2023-10-01 08:15:07 +00:00
type: article
2023-09-28 14:46:10 +00:00
unique-id: WOS:000559715700001
usage-count-last-180-days: '0'
usage-count-since-2013: '1'
volume: '16'
web-of-science-categories: Medicine, General \& Internal
year: '2019'