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BACKGROUND Back pain remains a challenge for primary care internationally. One model that has not been tested is stratification of the management according to the patient's prognosis (low, medium, or high risk). We compared the clinical effectiveness and cost-effectiveness of stratified primary care (intervention) with non-stratified current best practice(More)
OBJECTIVE To develop and validate a tool that screens for back pain prognostic indicators relevant to initial decision making in primary care. METHODS The setting was UK primary care adults with nonspecific back pain. Constructs that were independent prognostic indicators for persistence were identified from secondary analysis of 2 existing cohorts and(More)
STUDY OBJECTIVES To investigate the incidence, persistence, and consequences of insomnia and their associations with psychological health and pain. DESIGN A population based, longitudinal, cohort study using postal questionnaires at baseline and 12-month follow-up. Sleep problems in the past month were assessed using 4 questions: insomnia was defined as(More)
The reproductive hormone, relaxin, is structurally similar to insulin and insulin-like growth factor (IGF). Although a number of cellular responses to relaxin have been described, intracellular signaling mechanisms that link relaxin receptor engagement to alterations in gene expression remain uncharacterized. In the present study, relaxin treatment of a(More)
OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of nurse-led care (NLC) for people with rheumatoid arthritis (RA). METHODS In a multicentre pragmatic randomised controlled trial, the assessment of clinical effects followed a non-inferiority design, while patient satisfaction and cost assessments followed a superiority design.(More)
BACKGROUND Recommendations for the management of low back pain in primary care emphasise the importance of recognising and addressing psychosocial factors at an early stage. We compared the effectiveness of a brief pain-management programme with physiotherapy incorporating manual therapy for the reduction of disability at 12 months in patients consulting(More)
In a prospective study of chlamydial and mycoplasmal infections in pregnancy, Chlamydia trachomatis occurred in 8.0%, Mycoplasma hominis in 23.5%, and Ureaplasma urealyticum in 72.3% of 1,365 enrollees. By multivariate analysis, C trachomatis was correlated with lower socioeconomic status, age 23 years or younger, and 12 years or less of schooling.(More)
AIM This paper reports a study to test the hypothesis that consultation with a clinical nurse specialist in a drug monitor clinic has a measurable impact on the well-being of patients with rheumatoid arthritis. METHOD A single blinded randomized controlled trial was carried out with 71 patients with rheumatoid arthritis who were starting new(More)
OBJECTIVE To determine whether manual therapy or pulsed shortwave diathermy, in addition to advice and exercise, provide better clinical outcome at 6 months than advice and exercise alone in primary care patients with nonspecific neck disorders. METHODS This was a multicenter, 3-arm randomized controlled trial in 15 physical therapy departments. Of the(More)
OBJECTIVES To estimate the sensitivity to change and internal consistency of the Northwick Park Neck Pain Questionnaire (NPQ) and derive its minimal clinically important difference (MCID). METHODS Data on 311 participants in a randomized controlled trial of physical therapy for neck pain were analyzed, between baseline and 6-month follow-up. Cronbach(More)