| Optimal case definitions of upper limb disorder for use in the clinical treatment and referral of patients. | |
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MedLine Citation:
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PMID: 22213545 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE: Experts disagree about the optimal classification of upper limb disorders (ULDs). To explore whether differential response to treatments offers a basis for choosing between case definitions, we analysed previously published research. METHODS: We screened 183 randomised controlled trials (RCTs) of treatments for ULDs, identified from the bibliographies of 10 Cochrane reviews, four other systematic reviews, and a search in Medline, Embase, and Google Scholar to June 2010. From these, we selected RCTs which allowed estimates of benefit (expressed as relative risks (RRs)) for >1 case definition to be compared when other variables (treatment, comparison group, follow-up time, outcome measure) were effectively held constant. Comparisons of RRs for paired case definitions were summarised by their ratios, with the RR for the simpler and broader definition as the denominator. RESULT: Two RCT reports allowed within-trial comparison of RRs and thirteen others allowed between-trial comparisons. Together these provided 17 ratios of RRs (five for shoulder treatments, 12 for elbow treatments, none for wrist/hand treatments). The median ratio of RRs was 1.0 (range 0.3 to 1.7; interquartile range 0.6 to 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. © 2011 by the American College of Rheumatology. |
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Authors:
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Keith T Palmer; E Clare Harris; Cathy Linaker; Georgia Ntani; Cyrus Cooper; David Coggon |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-12-27 |
Journal Detail:
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Title: Arthritis care & research Volume: - ISSN: 2151-4658 ISO Abbreviation: - Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2012-1-3 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101518086 Medline TA: Arthritis Care Res (Hoboken) Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 by the American College of Rheumatology. |
Affiliation:
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Professor of Occupational Medicine, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. ktp@mrc.soton.ac.uk. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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