Document Detail

Optimal case definitions of upper extremity disorder for use in the clinical treatment and referral of patients.
MedLine Citation:
PMID:  22213545     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Experts disagree about the optimal classification of upper extremity disorders. To explore whether differential response to treatments offers a basis for choosing between case definitions, we analyzed previously published research.
METHODS: We screened 183 randomized controlled trials (RCTs) of treatments for upper extremity disorders identified from the bibliographies of 10 Cochrane reviews and 4 other systematic reviews, and a search in Medline, Embase, and Google Scholar to June 2010. From these, we selected RCTs that allowed estimates of benefit (expressed as relative risks [RRs]) for >1 case definition to be compared when other variables (treatment, comparison group, followup time, outcome measure) were effectively held constant. Comparisons of RRs for paired case definitions were summarized by their ratios, with the RR for the simpler and broader definition as the denominator.
RESULTS: Two RCT reports allowed within-trial comparison of RRs and 13 others allowed between-trial comparisons. Together these provided 17 ratios of RRs (5 for shoulder treatments, 12 for elbow treatments, and none for wrist/hand treatments). The median ratio of RRs was 1.0 (range 0.3-1.7, interquartile range 0.6-1.3).
CONCLUSION: Although the evidence base is limited, our findings suggest that for musculoskeletal disorders of the shoulder and elbow, clinicians in primary care will often do best to apply simpler and broader case definitions. Researchers should routinely publish secondary analyses for subgroups of patients by different diagnostic features at trial entry to expand the evidence base on optimal case definitions for patient management.
Keith T Palmer; E Clare Harris; Cathy Linaker; Georgia Ntani; Cyrus Cooper; David Coggon
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Arthritis care & research     Volume:  64     ISSN:  2151-4658     ISO Abbreviation:  Arthritis Care Res (Hoboken)     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-29     Completed Date:  2012-07-02     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  101518086     Medline TA:  Arthritis Care Res (Hoboken)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  573-80     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 by the American College of Rheumatology.
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
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MeSH Terms
Elbow Joint
Hand Joints
Musculoskeletal Diseases / classification,  diagnosis*
Patient Care Management*
Referral and Consultation*
Shoulder Joint
Terminology as Topic*
Upper Extremity*
Wrist Joint
Grant Support
MC_UP_A620_1018//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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