Differences In Mean Change Scores Research Articles

Effect of adding hip exercises to general rehabilitation treatment of knee osteoarthritis on patients’ physical functions: a randomized clinical trial

BackgroundHip adductor and abductor strength were both reduced in KOA patients. But to date, most of the researches have only focused on quadriceps combined with hip abductor strengthening versus quadriceps strengthening.ObjectiveThe aim of the study is to evaluate the effect of adding hip abductor and adductor strengthening to quadriceps strengthening on lower limb strength, knee pain and physical function in patients with medial compartmental knee osteoarthritis.MethodsIn this study, 42 participants, were randomly divided into two groups: the general treatment group (GT group) and the added-hip-exercise group (AH group). All participants were given a general rehabilitation treatment. The AH group performed hip abductor and adductor strengthening in addition to the general rehabilitation treatment. Knee and hip muscle strength, Five Times Sit-to-Stand Test (FTSST), the Timed Up and Go Test (TUGT), Numerical Rating Scale (NRS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were assessed at baseline and 6 weeks. A two-sided 2-sample unpaired t test was performed to compare the difference in mean change scores between AH and GT groups.ResultsFinally, 36 participants completed the study: both groups consist of 18 participants. In the per-protocol analysis, the AH group had a greater improvement in knee extension strength (mean changes, 7.84 versus 36.48; P < 0.001) and hip abduction strength (mean changes, 5.05 versus 26.62; P = 0.001) than the control group. Similarly, the AH group had a greater improvement in the FTSST time (mean changes, 0.40 s versus 3.57 s; P < 0.001) and the TUFT time (mean changes, 0.18 s versus 1.67 s; P = 0.002) than the GH group. No statistical difference was found in the change of WOMAC pain scores and NRS between the 2 groups.ConclusionsOlder adults with knee OA in the AH group had superior muscle strength, symptoms and daily activity performance at the 6th week than those in the GT group. And adding hip exercises could expedite improvement of pain at the 2th week, but not at the 6th week.Trial registrationClinical trial registration numbers and date of registration: ChiCTR-IOR-16009124, Registered 30 August 2016.

BRACHY: A Randomized Trial to Evaluate Symptom Improvement in Advanced Non-Small Cell Lung Cancer Treated With External Beam Radiation With or Without High-Dose-Rate Intraluminal Brachytherapy

Uncontrolled studies suggest that the addition of high-dose-rate intraluminal brachytherapy (HDRIB) to external beam radiation therapy (EBRT) may improve palliation for patients with advanced non-small cell lung cancer (NSCLC). The purpose of this study was to evaluate the potential clinical benefit of adding HDRIB to EBRT in a multicenter randomized trial. Patients with symptomatic stage III or IV NSCLC with endobronchial disease were randomized to EBRT (20 Gy in 5 daily fractions over 1 week or 30 Gy in 10 daily fractions over 2 weeks) or the same EBRT plus HDRIB (14 Gy in 2 fractions separated by 1 week). The primary outcome was the proportion of patients who achieved symptomatic improvement in patient-reported overall lung cancer symptoms on the Lung Cancer Symptom Scale (LCSS) at 6 weeks after randomization. Secondary outcomes included improvement in individual symptoms, symptom-progression-free survival, overall survival, and toxicity. The planned sample size was 250 patients based on detection of symptomatic improvement from 40% to 60% with a 2-sided α of .05 and 80% power. A total of 134 patients were randomized over 4.5 years: 67 to each arm. The study closed early owing to slow accrual. The mean age was 69.8 years, and 67% of patients had metastatic disease. At 6 weeks, 19 patients (28.4%) in the EBRT arm and 20 patients (29.9%) in the EBRT plus HDRIB arm experienced an improvement in lung cancer symptoms (P=.84). When limited to patients who completed the LCSS, percentages were 40.4% versus 47.6%, respectively (P=.49). Between group differences in mean change scores (0.3-0.5 standard deviations) in favor of EBRT plus HDRIB were observed for overall symptoms, but only hemoptysis was significantly improved (P=.03). No significant differences were observed in progression-free or overall survival. Grade 3/4 toxicities were similar between groups. Small to moderate improvements were seen in symptom relief with the combined therapy, but they did not reach statistical significance. Further research is necessary before recommending HDRIB in addition to EBRT for palliation of lung cancer symptoms.

Randomized Feasibility Pilot Trial of Adding a New Three-Dimensional Adjustable Posture-Corrective Orthotic to a Multi-Modal Program for the Treatment of Nonspecific Neck Pain.

The aim of this study was to investigate the feasibility and effect of a multimodal program for the management of chronic nonspecific neck pain CNSNP with the addition of a 3D adjustable posture corrective orthotic (PCO), with a focus on patient recruitment and retention. This report describes a prospective, randomized controlled pilot study with twenty-four participants with CNSNP and definite 3D postural deviations who were randomly assigned to control and study groups. Both groups received the same multimodal program; additionally, the study group received a 3D PCO to perform mirror image® therapy for 20−30 min while the patient was walking on a treadmill 2−3 times per week for 10 weeks. Primary outcomes included feasibility, recruitment, adherence, safety, and sample size calculation. Secondary outcomes included neck pain intensity by numeric pain rating scale (NPRS), neck disability index (NDI), active cervical ROM, and 3D posture parameters of the head in relation to the thoracic region. Measures were assessed at baseline and after 10 weeks of intervention. Overall, 54 participants were screened for eligibility, and 24 (100%) were enrolled for study participation. Three participants (12.5%) were lost to reassessment before finishing 10 weeks of treatment. The between-group mean differences in change scores indicated greater improvements in the study group receiving the new PCO intervention. Using an effect size of 0.797, α > 0.05, β = 80% between-group improvements for NDI identified that 42 participants were required for a full-scale RCT. This pilot study demonstrated the feasibility of recruitment, compliance, and safety for the treatment of CNSNP using a 3D PCO to a multimodal program to positively affect CNSNP management.

Withdrawal of intravenous immunoglobulin in chronic inflammatory demyelinating polyradiculoneuropathy.

Intravenous immunoglobulins are an efficacious treatment for chronic inflammatory demyelinating polyradiculoneuropathy. Biomarkers for disease activity are lacking, making the need for ongoing treatment difficult to assess, leading to potential overtreatment and high health-care costs. Our objective was to determine whether intravenous immunoglobulin withdrawal is non-inferior to continuing intravenous immunoglobulin treatment and to determine how often patients are overtreated.We performed a randomized, double-blind, intravenous immunoglobulin-controlled non-inferiority trial in seven centres in the Netherlands (Trial registration: ISRCTN 13637698; www.isrctn.com/ISRCTN13637698). Adults with clinically stable chronic inflammatory demyelinating polyradiculoneuropathy using intravenous immunoglobulin maintenance treatment for at least 6 months were included. Patients received either intravenous immunoglobulin withdrawal (placebo) as investigational treatment or continuation of intravenous immunoglobulin treatment (control). The primary outcome was the mean change in logit scores from baseline to 24-week follow-up on the patient-reported Inflammatory Rasch–Overall Disability Scale. The non-inferiority margin was predefined as between-group difference in mean change scores of −0.65. Patients who deteriorated could reach a relapse end point according to predefined criteria. Patients with a relapse end point after intravenous immunoglobulin withdrawal entered a restabilization phase. All patients from the withdrawal group who remained stable were included in an open-label extension phase of 52 weeks.We included 60 patients, of whom 29 were randomized to intravenous immunoglobulin withdrawal and 31 to continuation of treatment. The mean age was 58 years (SD 14.7) and 67% was male. The between-group difference in mean change Inflammatory Rasch–Overall Disability Scale scores was −0.47 (95% CI −1.24 to 0.31), indicating that non-inferiority of intravenous immunoglobulin withdrawal could not be established. In the intravenous immunoglobulin withdrawal group, 41% remained stable for 24 weeks, compared to 58% in the intravenous immunoglobulin continuation group (−17%; 95% CI −39 to 8). Of the intravenous immunoglobulin withdrawal group, 28% remained stable at the end of the extension phase. Of the patients in the restabilization phase, 94% restabilized within 12 weeks.In conclusion, it remains inconclusive whether intravenous immunoglobulin withdrawal is non-inferior compared to continuing treatment, partly due to larger than expected confidence intervals leading to an underpowered study. Despite these limitations, a considerable proportion of patients could stop treatment and almost all patients who relapsed were restabilized quickly. Unexpectedly, a high proportion of intravenous immunoglobulin-treated patients experienced a relapse end point, emphasizing the need for more objective measures for disease activity in future trials, as the patient-reported outcome measures might not have been able to identify true relapses reliably. Overall, this study suggests that withdrawal attempts are safe and should be performed regularly in clinically stable patients.

Quality of Life and Caregiver Burden in Patients and Their Caregivers Undergoing Outpatient Autologous Stem Cell Transplantation Compared to Inpatient Transplantation

Quality of Life and Caregiver Burden in Patients and Their Caregivers Undergoing Outpatient Autologous Stem Cell Transplantation Compared to Inpatient Transplantation

Minimal clinically important difference of the Four Square Step Test in people with degenerative spinal conditions

ObjectiveTo identify the minimal clinically important difference (MCID) in the Four Square Step Test (FSST) for patients with degenerative spinal conditions before and after a six-week group-based physiotherapy programme. DesignSecondary analysis of a longitudinal cohort study. SettingPhysiotherapy department within a specialised orthopaedic hospital in the UK. ParticipantsMen and women with degenerative spinal conditions. InterventionsAll participants had a routine care package of up to six group-based physiotherapy led exercise and education sessions. Main outcome measuresAn anchor-based approach using a self-report outcome measure (Activities-specific Balance Confidence [ABC] Scale) was utilised as a comparator to determine the MCID of the FSST. The MCID for the FSST was calculated as the difference in mean change scores from those who improved on the ABC Scale against those who did not improve (based on the standard error of measurement of the ABC Scale). ResultsTwenty-eight participants with degenerative spinal conditions (19 female) had a mean age of 73 years (SD 7.7). The mean ABC Scale scores for the whole sample were 61% (SD 19.1) at baseline and 66% (SD 18.3) post-physiotherapy. The mean FSST scores for the whole sample were 19.1seconds (SD 9.8) at baseline and 13.9seconds (SD 6.3) post-physiotherapy. The MCID for the FSST was 3.6seconds. ConclusionsThe MCID for improvement in balance was 3.6seconds, indicating people with degenerative spinal conditions are likely to perceive an improvement of ≥3.6seconds in their FSST score as an important change in their balance performance and confidence.

DBT-informed treatment in a partial hospital and intensive outpatient program: the role of step-down care.

Few studies to date have examined Partial Hospital (PH) and Intensive Outpatient (IOP) programs that utilize a Dialectical Behavior Therapy (DBT)-informed model. Preliminary findings suggest that DBT-informed PH programs are effective in reducing clinical symptoms; however, less is known about IOP programs as well as step-down care models. The present study utilized clinically relevant outcome indices and included a heterogeneous clinical sample. Specifically, the present study assessed pre-post data to examine changes in symptoms of depression, anxiety, hopelessness, and overall degree of suffering from intake to discharge in DBT-informed PH and IOP programs as well as a step-down condition (PH to IOP). Participants included 205 adults (ages M = 35.28, SD = 12.49). The sample was predominantly female (N = 139, 67.8%) and Caucasian (N = 181, 88.3%). The sample was divided into three distinct groups: PH program patients, PH to IOP program step-down patients, and IOP patients. Findings indicated significant symptom reduction from intake to discharge for all three conditions. There were no significant differences in mean change scores in symptom reduction between the three groups. Severity of depression symptoms at intake predicted program placement. However, type of program did not predict significant changes in symptoms from intake to discharge. This DBT-informed PH and IOP program was successful at reducing various psychiatric symptoms in the sample. Clinicians might consider the advantages of placing patients with higher symptoms of depression into PH programs with the intention of transitioning to step-down care through IOP programs that utilize DBT.

SettleIN: Using a Manualised Intervention to Facilitate the Adjustment of Older Adults with Dementia Following Placement into Residential Care.

The authors examined the feasibility of delivering an adapted version of SettleIN, a manualised staff-led programme designed to facilitate adjustment to care for new residents with dementia. The effects of SettleIN on resident adjustment, mood and quality of life were also investigated. A pilot randomised controlled trial was conducted. Nineteen new residents with dementia and 21 staff participants were recruited. Residents were randomly assigned to receive the SettleIN programme or residential care as usual. Resident quality of life, mood and overall adjustment were measured at baseline and post-intervention, in week seven. Interviews were conducted with staff in week seven to explore intervention feasibility. Despite medium to large effect sizes, there was no significant difference in mean change scores between the two conditions, with regards to quality of life, psychological wellbeing or overall adjustment outcomes. Qualitative feedback indicated that SettleIN was not feasible across all areas, with problems around recruitment and practicality. However, SettleIN was deemed feasible in terms of retention and acceptability among staff. The majority of staff felt that SettleIN was beneficial for residents but that organisational and programme factors impacted upon intervention feasibility. Further exploration of organisational barriers is needed in order to reduce the impact of such factors on care home research.

Effectiveness of mindfulness-based cognitive therapy in patients with anxiety disorders in secondary-care settings: A randomized controlled trial.

The primary objective of this study was to examine the effectiveness of mindfulness-based cognitive therapy (MBCT) in secondary-care settings where the vast majority of the patients have already undergone pharmacotherapy but have not remitted. Eligible participants were aged between 20 and 75 years and met the criteria for panic disorder/agoraphobia or social anxiety disorder specified in the DSM-IV. They were randomly assigned to either the MBCT group (n = 20) or the wait-list control group (n = 20). The primary outcome was the difference in mean change scores between pre- and post-intervention assessments on the State-Trait Anxiety Inventory (STAI). The outcome was analyzed using an intent-to-treat approach and a mixed-effect model repeated measurement. We observed significant differences in mean change scores for the STAI State Anxiety subscale (difference, -10.1; 95% confidence interval, -16.9 to -3.2; P < 0.005) and STAI Trait Anxiety subscale (difference, -11.7; 95% confidence interval, -17.0 to -6.4; P < 0.001) between the MBCT and control groups. MBCT is effective in patients with anxiety disorders in secondary-care settings where the vast majority of patients are treatment-resistant to pharmacotherapy.

An augmented prescribed exercise program (APEP) to improve mobility of older acute medical patients \u2013 a randomized, controlled pilot and feasibility trial

BackgroundThere is inconclusive evidence for the effectiveness of additional exercise in older hospital patients. The aims of this study were (1) to assess the feasibility of an augmented prescribed exercise program (APEP) in older acute medical patients and (2) to measure the potential effects of APEP on mobility capacity in order to assess the feasibility of a large full-scale study.MethodsWe conducted a single-center, prospective, parallel-group, single-blinded, randomized (1:1) controlled pilot and feasibility trial. Participants were recruited from acute geriatric wards of a general hospital. Key inclusion criteria were: age ≥ 65 years and walking ability. Key exclusion criteria were severe cognitive impairment and medical restriction for physical exercise interventions.Both groups received usual care, including physiotherapy. Intervention group participants were scheduled for additional exercise sessions (20–30 min, 4-5x/week). Feasibility of the trial design was assessed along pre-defined criteria for process, resources and management. Feasibility of the APEP intervention was analyzed by means of adherence, compliance and safety. Outcomes were measured at baseline and prior to hospital discharge. The primary outcome was mobility capacity (de Morton Mobility Index; DEMMI). Secondary outcomes were walking ability, physical endurance, fear of falling, frailty and length of stay.ResultsThirty-five participants were recruited (recruitment rate 20.3%). We lost 7 participants to follow-up (retention rate: 80%). Intervention group participants (n = 17) each participated in 5.3 ± 2.2 additional exercise sessions (mean duration: 23.2 ± 4.0 min; mean adherence rate 78% ± 26%). No severe adverse events occurred during study assessments or APEP sessions.There were no statistically significant differences in mean change scores in any outcome measure. A sample of 124 participants would be required to detect a difference of 4 DEMMI points (ES = 0.45) with a power of 80%.ConclusionsThis small feasibility RCT indicates that an APEP intervention may be safe and feasible in older acute medical patients. APEP may possibly induce small to moderate effects on mobility, but the clinical relevance of these effects may be limited. These results inform the planning of a larger-scale phase III study.Trial registrationGerman Clinical Trials Register (DRKS00011262). Registered 27 October 2016.

The Physiotherapy for Femoroacetabular Impingement Rehabilitation STudy (physioFIRST): A Pilot Randomized Controlled Trial.

Study Design A pilot double-blind randomized controlled trial (RCT). Background The effectiveness of physical therapy for femoroacetabular impingement syndrome (FAIS) is unknown. Objectives To determine the feasibility of an RCT investigating the effectiveness of a physical therapy intervention for FAIS. Methods Participants were 17 women and 7 men (mean ± SD age, 37 ± 8 years; body mass index, 25.4 ± 3.4 kg/m2) with FAIS who received physical therapy interventions provided over 12 weeks. The FAIS-specific physical therapy group received personalized progressive strengthening and functional retraining. The control group received standardized stretching exercises. In addition, both groups received manual therapy, progressive physical activity, and education. The primary outcome was feasibility, including integrity of the protocol, recruitment and retention, outcome measures, randomization procedure, and sample-size estimate. Secondary outcomes included hip pain and function (international Hip Outcome Tool-33 [iHOT-33]) and hip muscle strength. Poststudy interviews were conducted to determine potential improvements for future studies. Results Twenty-four (100%) patients with known eligibility agreed to participate. Four patients (17%) were lost to follow-up. All participants and the tester remained blinded, and the control intervention was acceptable to participants. The between-group mean differences in change scores were 16 (95% confidence interval [CI]: -9, 38) for the iHOT-33 and 0.24 (95% CI: 0.02, 0.47) Nm/kg for hip adduction strength, favoring the FAIS-specific physical therapy group. Using an effect size of 0.61, between-group improvements for the iHOT-33 suggest that 144 participants are required for a full-scale RCT. Conclusion A full-scale RCT of physical therapy for FAIS is feasible. A FAIS-specific physical therapy program has the potential for a moderate to large positive effect on hip pain, function, and hip adductor strength. Level of Evidence Therapy, level 2b. J Orthop Sports Phys Ther 2018;48(4):307-315. doi:10.2519/jospt.2018.7941.

Management of patients with functional neurological symptoms: a single-centre randomised controlled trial

ObjectiveIs health-related quality of life 12 months after randomisation in participants with functional neurological symptoms better after discussion of the diagnosis by trained neurologists who schedule at least two follow-up...

Patient-reported outcomes after lumbar epidural steroid injection for degenerative spine disease in depressed versus non-depressed patients

Background ContextMedical interventional modalities such as lumbar epidural steroid injections (LESIs) are often used in the setting of lumbar spine disorders where other conservative measures have failed. Concomitant depression can lead to worse outcomes in lumbar spine pathology. A number of studies have demonstrated an association between preoperative depression and poor outcomes following surgery, but the effect of depression on outcomes following medical interventional modalities is poorly understood. PurposeTo evaluate the differences in patient-reported outcomes (PROs) between depressed and non-depressed patients undergoing LESI. Study Design/SettingThis study is an analysis of a prospective longitudinal registry database at a single academic institution. Patient SampleAll patients undergoing LESI from 2012 to 2014 were eligible for enrollment into a prospective, web-based registry. Eligible patients had radicular pain, correlative imaging findings of degenerative pathology, and failed 6 weeks of conservative care. Outcome MeasuresThe PROs measured included the (1) numeric rating scale for back pain (NRS-BP), (2) numeric rating scale for leg pain (NRS-LP), (3) disease-specific physical disability—Oswestry Disability Index (ODI), and (4) preference-based health status—EuroQol-5D (EQ-5D). Materials and MethodsPatients who met the inclusion criteria underwent LESI. Patient-reported outcomes were collected at baseline and at 12 months following treatment. Based on previously validated values for the Zung Depression Scale (ZDS) as a screening tool for depression, patients were dichotomized into non-depressed (ZDS score ≤33) and depressed (ZDS score >33). The PRO change scores from baseline to 12 months were calculated. The mean absolute and change scores between the groups were compared using Student t test. Multivariable linear regression analysis for ODI, EQ-5D, NRS-LP, and NRS-BP was performed. ResultsA total of 161 patients with complete 12-month follow-up were included. Seventy-one patients (44%) were classified as depressed and 90 patients (56%) were classified as non-depressed. The mean baseline PRO scores were significantly worse in depressed patients compared with non-depressed patients: ODI (p<.001), NRS-BP (p=.013), NRS-LP (p<.001), and EQ-5D (p=.001). The mean absolute scores at 12 months were significantly lower in the depressed versus non-depressed patients: ODI (p<.001), NRS-BP (p=.001), NRS-LP (p=.05), and EQ-5D (p=.003). However, there was no difference in mean change scores observed at 12 months between the depressed and non-depressed cohorts: ODI (p=.42), NRS-BP (p=.31), NRS-LP (p=.25), EQ-5D (p=.14). Adjusting for pre-procedure variables, the higher ZDS score was associated with higher disability (ODI) at 12 months. ConclusionsDepression led to worse absolute scores for PROs and is associated with higher disability following LESI. However, patients with depressive symptoms can expect similar improvement in PROs at 12 months.

Test-retest Reliability and Practice Effects of the Turkish Version of Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in Healthy Persons

ABS TRACT: Test-retest reliability and practice effects of the Turkish version of Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in healthy persons Objective: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely used screening instrument in neuropsychological assessment. The present study aims to assess the reliability and practice effects of the Turkish version of the RBANS Form A in healthy persons. Methods: Data from 95 healthy volunteers (actively working and living in Ankara) were obtained. The subjects (48 M, 47 F) were between 20 and 49 years of age. The educational background of the subjects is characterized as follows: 33 subjects graduated from primary school (5-8 years), 33 from high school (9-11 years), and 29 from university (12+ years).Time period between test and retest ranged from 28 to 43 days. For the inter-rater reliability coefficient, 2 trained scorers blindly scored 51 random standardization samples for figure copy/recall subtests. Test-retest stability coefficients were assessed by Pearson correlation coefficient. Practice effect was assessed by paired t test and effect sizes. For internal consistency, Cronbach’s α was calculated. Results: The test-retest coefficients ranged from 0.59 to 0.88 for the indices and from 0.45 to 0.93 for the subtests. Figure copy (p=0.90), picture naming (p=0.56), semantic fluency (p=0.36) subtests and visuospatial/ constructional (p=0.42), language indices (p=0.19), and mean differences in change scores were minimal. For the other subtests and index scores, the differences between the tests were significant (p 0.10). Cronbach’s alpha coefficient for the RBANS was 0.86. The figure copy and figure recall subtests’ inter-rater reliability coefficients were 0.83 and 0.84, respectively (both p<0.001). Conclusions: The Turkish version of the RBANS (form A) showed adequate reliability, and it can be used as a short screening tool for neuropsychological performance.

Water fluoridation for the prevention of dental caries.

Water fluoridation for the prevention of dental caries.

Efficacy and adverse effects of ginkgo biloba for cognitive impairment and dementia: a systematic review and meta-analysis.

Research into Ginkgo biloba has been ongoing for many years, while the benefit and adverse effects of Ginkgo biloba extract EGb761 for cognitive impairment and dementia has been discussed controversially. To discuss new evidence on the clinical and adverse effects of standardized Ginkgo biloba extract EGb761 for cognitive impairment and dementia. MEDLINE, EMBASE, Cochrane, and other relevant databases were searched in March 2014 for eligible randomized controlled trials of Ginkgo biloba EGb761 therapy in patients with cognitive impairment and dementia. Nine trials met our inclusion criteria. Trials were of 22-26 weeks duration and included 2,561 patients in total. In the meta-analysis, the weighted mean differences in change scores for cognition were in favor of EGb761 compared to placebo (-2.86, 95%CI -3.18; -2.54); the standardized mean differences in change scores for activities in daily living (ADLs) were also in favor of EGb761 compared to placebo (-0.36, 95%CI -0.44; -0.28); Peto OR showed a statistically significant difference from placebo for Clinicians' Global Impression of Change (CGIC) scale (1.88, 95%CI 1.54; 2.29). All these benefits are mainly associated with EGb761 at a dose of 240 mg/day. For subgroup analysis in patients with neuropsychiatric symptoms, 240 mg/day EGb761 improved cognitive function, ADLs, CGIC, and also neuropsychiatric symptoms with statistical superiority than for the whole group. For the Alzheimer's disease subgroup, the main outcomes were almost the same as the whole group of patients with no statistical superiority. Finally, safety data revealed no important safety concerns with EGb761. EGb761 at 240 mg/day is able to stabilize or slow decline in cognition, function, behavior, and global change at 22-26 weeks in cognitive impairment and dementia, especially for patients with neuropsychiatric symptoms.

OP0140-HPR Preliminary Results of A Randomized Clinical TRIAL Comparing the Effectiveness of A Non-Pharmacological Multidisciplinary Group-Based Treatment Program with A Telephone Monitored Program on Daily Function in Patients with Generalized Osteoarthritis

BackgroundIt has been suggested that individuals with generalized osteoarthritis (GOA) represent a large subgroup of patients with OA1. However, the effectiveness of a non-pharmacological intervention in the management of GOA...

Effectiveness of an interactive postgraduate educational intervention with patient participation on the adherence to a physiotherapy guideline for hip and knee osteoarthritis: a randomised controlled trial

Purpose: To determine the effectiveness of an interactive educational intervention on a physiotherapy guideline for hip and knee osteoarthritis. Method: Physiotherapists were randomly allocated to a 3-h interactive educational course with the collaboration of three patient partners or no intervention. Assessments comprised questionnaires on adherence (score range 0–24), knowledge (score range 0–76), and barriers to use the guideline (score range 0–80). Assessments were conducted 1 week before the interactive course (T0) immediately after (T1), and 3 months thereafter (T2). Change scores were compared between the groups by means of Mann–Whitney U tests and linear mixed models. Results: 284 of 4328 eligible PTs (7%) were included. The intervention (n = 133) was significantly more effective than no intervention (n = 151) concerning self-reported adherence and knowledge with mean differences in change scores (95% CI) at T1 and T2 being 1.4 (0.7–2.0) and 0.9 (0.2–1.7) for adherence and 6.8 (4.5–9.1) and 3.9 (1.7–6.2) for knowledge, (all p values < 0.005). In both groups the barrier score increased at T1 and decreased at T2, with a significantly larger increase at T1 and decrease at T2 in the intervention group (mean differences 3.1 (1.8–4.4) and 3.3 (0.5–6.1), respectively. Conclusions: A short interactive educational course with patient participation on a PT guideline on hip and knee osteoarthritis showed a small to moderate positive effect on self-reported guideline adherence and knowledge, whereas for perceived barriers an advantage was only seen on the longer term.Implications for RehabilitationContinuing professional development is important and effective, it works very well when patients are engaged in the process, and hence it is supportive overall of enhancing clinical practice.Interactive education can reduce barriers in guideline usage in daily practice.

Using Patient-Reported Outcomes in Clinical Practice: A Promising Approach?

pletion only (attention-control), and no PRO completion (control). They found that the intervention improved discussion of symptoms but did not change treatment. Further, although the intervention demonstrated benefits in health-related quality of life (HRQOL) compared with the control group, there were no statistically significant differences in mean change scores between the intervention and attention-control group. This study by Wolfe et al 1 adds to this body of knowledge by investigating the use of PROs to aid treatment of pediatric patients with advanced cancer. The 104 patients and their parents enrolled in this trial completed a computerized battery of PRO questionnaires, at most once a week, and were monitored for 3 months, with the option of re-enrolling after each 3-month period. The PRO measures included a symptom assessment, an HRQOL questionnaire, and an overall sickness question. The results of these PRO assessments for the intervention group (n 51) were provided to both the oncologist and the families, with e-mail alerts to clinical team members for scores that exceeded predetermined thresholds. There was no feedback of the data in the control group. The investigators hypothesized that the intervention would lead to decreased symptom distress and improved HRQOL. They also assessed participant and provider satisfaction with the intervention. In the primary analysis, although changes were in the expected directions, there were no statistically significant differences between study arms on average symptom, HRQOL, or sickness scores over 20 weeks. Post hoc subgroup analyses found larger and statistically significant improvements on the HRQOL emotional domain scores and the sickness question for patients who survived longer than 20 weeks, particularly those who were at least 8 years old. There was also a suggestion that emotional function improved among children 8 years and older, regardless of length of survival, although this was not statistically significant. Likewise, children who both survived longer than 20 weeks and were at least 8-years old also demonstrated changes of marginal statistical significance on the total and physical HRQOL domains. In terms of satisfaction with the intervention, 28% of children and 54% of parents reported the intervention helped them talk to the doctor quite a bit or very much, and 75% of parents said the intervention often or almost always helped them understand how their child feels. Among the clinicians, 50% strongly agreed or agreed that the PRO reports were useful when speaking to patients, with 61%

The effect of mandibular 2‐implant overdentures on oral health–related quality of life: an international multicentre study

To determine the difference in oral health-related quality of life (OHRQoL) in patients who received mandibular 2-implant overdentures and conventional dentures in a pragmatic international study. In this prospective study, data were gathered from 203 edentulous patients (mean age, 68.8; SD: 10.4years) at eight centres in North America, South America and Europe. The patients were provided with new mandibular conventional dentures or implant overdentures supported by 2 implants and ball attachments and opposed by conventional dentures. At baseline and at 6months post-treatment, patients rated their oral health-related quality of life using the OHIP-20. A significantly higher proportion of the participants in the implant group in North America reported improvement in both the psychological and the handicap domains, compared to those who received conventional dentures (93% vs. 52%; P<0.05). In South America, 100% of participants who received implant overdentures reported improvement in physical pain, compared to 66% in the conventional group (P<0.05). Differences in mean change scores among those who expressed improvement were not significantly different between sites or treatments. Mandibular 2-implant overdentures are more likely than conventional dentures to improve OHRQL for edentulous patients. Cultural differences were also observed in the impact of implant overdentures on the different domains of the OHIP-20.