Mean Difference In Visual Analog Scale Research Articles

Chronic Calcific Tendonitis of the Rotator Cuff: A Systematic Review and Meta-analysis of Randomized Controlled Trials Comparing Operative and Non-operative Interventions.

Calcific tendinitis is a relatively common shoulder disorder, with 7% to 17% of individuals with shoulder pain having rotator cuff calcium deposits. Several nonoperative interventions, extracorporeal-shockwave-therapy (ESWT) and ultrasound-guided-needling (UGN), and surgical techniques have been described to treat calcific tendonitis with satisfactory outcomes. Clinical guidelines are lacking for surgical excision in cases refractory to nonoperative treatment. Several arthroscopic and open operative techniques have been described to treat calcific tendonitis with satisfactory clinical outcomes. The purpose of this systematic review of randomized controlled trials is to compare outcomes and complications of nonoperative versus operative management of chronic calcific tendinitis of the rotator cuff, to provide evidence-based treatment guidelines for practitioners. EMBASE, PubMed, and OVID [MEDLINE] were searched from database inception until February 20, 2022, for randomized controlled trials reporting outcomes related to operative or nonoperative management for calcific tendonitis of the shoulder. Clinical outcomes including pain on visual analog scale (VAS), Constant-Murley Shoulder Outcome Score (CMS), and resolution of calcific deposits were evaluated. Continuous data at last follow-up was pooled into mean differences using a random effects model for meta-analysis. A total of 27 studies (2,212 nonoperative patients and 140 operative patients) met the final inclusion criteria. Pooled mean difference in VAS for ESWT was -3.83 (95% Confidence Interval [CI] -5.38, -2.27); p < 0.00001), compared to -4.83 (95%CI -5.44, -4.22; p < 0.00001) for UGN, and -4.65 (95%CI -5.47, -3.82; p < 0.00001) for the operative interventions. Pooled mean difference in CMS score after ESWT was 18.30 (95%CI 10.95, 25.66; p < 0.00001) compared to 22.01 (95%CI 8.17, 35.84; p = 0.002) for UGN, and 38.35 (95%CI 31.68, 45.02; p < 0.00001) for the operative interventions. 85% of patients receiving operative and 67% of patients receiving UGN management had complete radiographic resolution of calcific deposit. Surgical treatment of chronic calcific tendonitis of the rotator cuff results in larger improvement in functional outcome scores and comparable pain reduction to nonoperative interventions, particularly UGN. Both operative and nonoperative treatment modalities are likely to have clinically significant improvements in function and pain and thus it is reasonable to trial UGN and ESWT as first-line treatment. Cost-effectiveness analyses will be needed to support one treatment over the other. High quality RCTs directly comparing nonoperative interventions to operative interventions in patients prior to failing conservative treatment are needed to establish high-quality evidence-based guidelines.

The effects of earplugs and eye masks on sleep quality of patients admitted to coronary care units: A randomised clinical trial.

Sleep is an essential need for patients admitted to coronary care units. The present clinical trial aimed to determine the effect of using eye masks and earplugs on the sleep quality of patients with coronary heart disease (CHD). A total of 68 eligible patients with CHD were randomly allocated into four groups of 17 (control, eye masks, earplugs, and eye masks with earplugs). All three interventions were performed during the night from 10:00p.m. to 7:00a.m. the next day. The outcomes were the quality of sleep, measured by the Verran and Snyder-Halpern (VSH) Sleep Scale, and the urinary levels of nocturnal melatonin and cortisol, measured by urine samples taken during the night (from 10:00p.m. to 7:00a.m.). The study outcomes were measured on the third and fourth days. Sleep disturbance was statistically significantly lower in patients with earplugs (visual analogue scale mean difference [MD]: 74.31mm, SE: 11.34, p=0.001). Sleep effectiveness was statistically significantly higher in patients with eye mask (MD: 36.88mm, SE: 8.75, p=0.001). The need for sleep supplementation was statistically significantly lower in patients with eye masks (MD: 39.79mm, SE: 7.23, p=0.001). There was a significant difference in melatonin levels between eye masks and the control group (p=0.03). For urinary cortisol levels, there were significant differences between eye masks and the control group (p=0.007), earplugs and the control group (p=0.001), and eye masks with earplugs and the control group (p=0.006). The mean scores for comfort, effectiveness, and ease of use were highest for the group that used eye masks (2.88, 2.94, and 3.18, respectively). As a result, all three interventions improved the sleep quality of patients. However, the interventions had different effects on the three dimensions of the VSH Sleep Scale, as well as the urinary levels of cortisol and melatonin.

Effectiveness of Epiduroscopy for Patients with Failed Back Surgery Syndrome: A Systematic Review and Meta-analysis.

IntroductionLow‐back or leg pain in patients suffering from failed back surgery syndrome (FBSS) is often severe, having a major impact on functionality and quality of life. Despite conservative and surgical treatments, pain can be persistent. An alternative treatment option is epiduroscopy, a minimally invasive procedure based on mechanical adhesiolysis of epidural fibrosis. As epidural fibrosis is speculated to be a major contributor in the pathophysiologic process of FBSS, this review evaluates the effectiveness of epiduroscopy in FBSS patients.Methods and materialsA systematic literature search was performed in PubMed, Embase, and Cochrane databases. Critical appraisal was performed using validated tools. Meta‐analysis was performed using generic inverse variance analysis.ResultsFrom the 286 identified articles, nine studies were included. The visual analogue scale (VAS) average was 7.6 at baseline, 4.5 at 6, and 4.3 at 12 months. The Oswestry Disability Index (ODI) average was 61.7% at baseline, 42.8% at 6, and 46.9% at 12 months. An average of 49% of patients experienced significant pain relief at 6 and 37% at 12 months. Meta‐analysis showed a pooled VAS mean difference of 3.4 (2.6 to 4.1; 95% confidence interval [CI]) and 2.8 (1.6 to 4.0; 95% CI) and pooled ODI mean difference of 19.4% (12.5 to 26.4%; 95% CI) and 19.8% (13.8 to 25.9%; 95% CI) at 6 and 12 months, respectively.ConclusionCurrent literature demonstrates a clinically relevant reduction in pain and disability scores at 6 to 12 months after mechanical adhesiolysis in FBSS patients. The quality of evidence is moderate, and the level of recommendation is weak. Practitioners should consider the benefits of epiduroscopy after weighing the risks for individual patients with FBSS.

Oral prednisolone for acute otitis media in children: a pilot, pragmatic, randomised, open-label, controlled study (OPAL study)

BackgroundAcute otitis media (AOM) is associated with high antibiotic prescribing rates. Antibiotics are somewhat effective in improving pain and middle ear effusion (MEE); however, they have unfavourable effects. Alternative treatments, such as corticosteroids as anti-inflammatory agents, are needed. Evidence for the efficacy of these remains inconclusive. We conducted a pilot study to test feasibility of a proposed large-scale randomised controlled trial (RCT) to assess the efficacy of corticosteroids for AOM.MethodsWe conducted a pilot, pragmatic, parallel, open-label RCT of oral corticosteroids for paediatric AOM in primary and secondary/tertiary care centres in Indonesia. Children aged 6 months–12 years with AOM were randomised to either prednisolone or control (1:1). Physicians were blinded to allocation. Our objectives were to test the feasibility of our full RCT procedures and design, and assess the mechanistic effect of corticosteroids, using tympanometry, in suppressing middle ear inflammation by reducing MEE.ResultsWe screened 512 children; 62 (38%) of 161 eligible children were randomised and 60 were analysed for the primary clinical outcome. All study procedures were completed successfully by healthcare personnel and parents/caregivers, despite time constraints and high workload. All eligible, consenting children were appropriately randomised. One child did not take the medication and four received additional oral corticosteroids. Our revised sample size calculation verified 444 children are needed for the full RCT. Oral corticosteroids did not have any discernible effects on MEE resolution and duration. There was no correlation between pain or other symptoms and MEE change. However, prednisolone may reduce pain intensity at day 3 (Visual Analogue Scale mean difference − 7.4 mm, 95% confidence interval (CI) − 13.4 to − 1.3, p = 0.018), but cause drowsiness (relative risk (RR) 1.8, 95% CI 1.1 to 2.8, p = 0.016). Tympanometry curves at day 7 may be improved (RR 1.8, 95% CI 1.0 to 2.9). We cannot yet confirm these as effects of corticosteroids due to insufficient sample size in this pilot study.ConclusionsIt is feasible to conduct a large, pragmatic RCT of corticosteroids for paediatric AOM in Indonesia. Although oral corticosteroids may reduce pain and improve tympanometry curves, it requires an adequately powered clinical trial to confirm this.Trial registrationStudy registry number: ACTRN12618000049279. Name of registry: the Australian New Zealand Clinical Trials Registry (ANZCTR). Date of registration: 16 January 2018.

Cluster randomised controlled trial evaluating the clinical and humanistic impact of a pharmacist-led minor ailment service

BackgroundCommunity pharmacists are well positioned to support patients’ minor ailments. The objective was to evaluate the clinical and humanistic impact of a minor ailment service (MAS) in community pharmacy compared...

Management of Lumbar Spondylolysis

Background: Spondylolysis is a fatigue fracture which occur in the pars interarticularis due to repetitive mechanical stresses on the lumbar spine. Objective: This work was aimed to discuss the different methods in management of spondylolysis, regarding the conservative treatment and surgical procedures. Patients and methods: This study included 30 cases with spondylolysis at Al-Azhar University Hospitals. 13 cases were operated upon in El-Sayed Galal Hospital of Al-Azhar University and 12 cases were operated upon in El-Hussin Hospital of Al-Azhar University with 5 cases were managed by conservative treatment between August 2017 and July 2019. Follow up was done for average one year. Results: The improvement of radiculopathy in our study was ranging into 3 category: Fair improvement (2 cases, 20%) with conservative treatment, Good improvement (2 cases, 20%) with decompression and fixation, and Excellent improvement (6 cases, 60%) also with decompression and fixation, so there was a statistical significant relation between both strategy (p-value=0.007), which indicate that the spondylolysis with radicular pain is better managed by decompression and fixation. In our study, we used the Visual Analogue Scale (VAS) in the all cases pre management and post management to assess the outcome. In our study, there was a significant change in Mean VAS score with mean VAS pre-management 7.1, mean VAS post management 2.6 and mean difference in VAS 4.5. Indicating a significant improvement of pain intensity (P<0.001). Conclusion: Spondylolysis is common in young females at L5 pars and presented with LBP in most cases. Different surgical procedure is safe and effective in management than conservative treatment.

Efficacy of Pharmacological Therapies for Adhesive Capsulitis of the Shoulder: A Systematic Review and Network Meta-analysis

Background: Several pharmacological interventions are used for the management of adhesive capsulitis of the shoulder, although the optimal treatment has yet to be defined. Purpose: To conduct a network meta-analysis to compare the effects of different pharmacological interventions for adhesive capsulitis, administered either alone or after distension of the shoulder capsule. Study Design: Network meta-analysis. Methods: The authors searched Scopus, PubMed, and the Cochrane Central Register of Controlled Trials up to April 22, 2018, for completed studies. They enrolled trials that assessed the results of different pharmacological treatments for the primary management of adhesive capsulitis. The primary outcome was pain relief as measured by self-administered questionnaires. The secondary outcome included the assessment of composite instruments that evaluated, at a minimum, pain and function. The authors clinically interpreted the results after back-transforming the standardized mean differences into mean differences in simple instruments and assessed the quality of the source studies using the Cochrane “risk of bias” tool. Results: The authors considered 30 trials with a total of 2010 participants in this systematic review. For pain relief, there was a significant difference in favor of intra-articular corticosteroids and distension of the shoulder capsule with steroids as compared with control in the short term (mean difference in visual analog scale (VAS): –1.4 [95% CI, −2.5 to −0.4] and −1.7 [95% CI, −3.2 to −0.1], respectively). Furthermore, rotator-interval injections were found to be superior to placebo (mean difference in VAS: –7.2; 95% CI, −10.1 to −4.4), although the intervention was considered in only 1 trial. Finally, there was a statistically significant difference in favor of multiple-site corticosteroid injections compared to placebo in both the short- (mean difference in Shoulder Pain and Disability Index [SPADI]: −86.7; 95% CI, −133.6 to −40) and intermediate-term assessment (mean difference in SPADI: −102.9; 95% CI, −163.9 to −41.8). Conclusion: Intra-articular corticosteroid intervention, administered either alone or after distension of the shoulder capsule, provided clinically meaningful improvements in the short term. Likewise, rotator-interval corticosteroid injections yielded promising results in terms of pain relief. However, these short-term benefits of steroids dissipated over time. Multiple-site corticosteroid injections showed clinical advantage over placebo for short- and intermediate-term composite outcome assessments.

Efficacy, Safety and Cost Effectiveness of Amitriptyline and Pregabalin in Patients with Diabetic Peripheral Neuropathy

The tricyclic antidepressant, amitriptyline and the anticonvulsant, pregabalin are the most frequently used medications in general practice for diabetic peripheral neuropathy. This study compares the effectiveness of amitriptyline vs. pregabalin using neuropathic pain symptom inventory and visual analogue scale, the incidence of adverse drug reactions and the cost effectiveness. Effectiveness was measured using visual analogue scale and neuropathic pain symptom inventory scores both before and after therapy. Adverse drug reactions were documented after the therapy and cost effectiveness was measured using incremental cost effectiveness analysis ratio. Both drugs showed obvious pain relief. Visual analogue scale mean difference scores showed statistically significant difference in efficacy for amitriptyline and pregabalin. Incidences of adverse drug reactions were more or less similar in terms of magnitude. Furthermore the cost of amitriptyline is less than that of pregabalin. Hence we concluded that amitriptyline was a better choice of therapy than pregablin because it was well tolerated and has a lower cost for the additional effectiveness achieved.

Effect of walking versus resistance exercise on pain and function in older adults with knee osteoarthritis

Context: Knee osteoarthritis (OA) is an important cause of pain and functional limitation in older people. Several short-term studies state that walking and resistance exercise reduce pain and disability and improve physical fitness in people with knee OA. Aims: To compare the effect of walking and resistance exercise on pain and function in older adults with knee OA. Materials and Methods: A quasi-experimental study was conducted at the physiotherapy department of General Hospital. Twenty one males and females in the age range of 60-75 years, diagnosed with knee OA by the orthopedic department according to the American College of Rheumatology criteria were randomly allocated into three groups. Conventional physiotherapy treatment remained common for all the groups. Group A subjects additionally walked at a self-paced speed. Group B subjects received resistance exercise for hip and knee muscles. Group C subjects received conventional physiotherapy treatment alone. Intervention was given 5 days/week for 2 weeks. Pain intensity at rest and during activity was assessed using visual analog scale (VAS) and physical function was assessed by Western Ontario McMasters Arthritic Index (WOMAC). The level of significance was set at 5%. Results: There was a significant difference in VAS at rest within group A and group B. The difference in VAS during activity and WOMAC scores was significant within each group. Mean difference in VAS during activity revealed a significant difference between group B and group A and between group B and group C. The mean difference in WOMAC scores was significant between group A and group C. Mean difference in VAS at rest showed no difference between the groups. Conclusion: Resistance exercises are more effective in reducing pain during activity and walking is more effective in improving physical function in older adults with knee OA.

Abstract WMP22: Third International Stroke Trial (IST-3): Effect Of iv rt-pa &lt; 6 Hours In Acute Ischaemic Stroke On Living Circumstances And Health Related Quality Of Life At Six Months

Aim: describe the effects of thrombolysis with iv rt-PA &lt; 6hrs on health related quality of life (HRQoL) &amp; living circumstances at 6 months. Methods: Randomised trial of iv rt-PA (0.9mg/kg) (n=1515) versus control (n=1520). At 6 months, patients were assessed by postal questionnaire or blinded telephone interview to determine living circumstances and HRQoL with the EQ5D-3L (including its visual analogue scale (VAS)(100=best, 0=worst) assessment of overall self-rated health. We: a) calculated the mean between-group difference in VAS self-rated health, b) analysed the 5 3-level domains of EQ5D by ordinal logistic regression. Analyses were adjusted for baseline prognostic factors (age, NIHSS, hours delay from onset to randomisation, and presence of visible ischaemia on the baseline scan). IST-3 is registered ISRCTN25765518 . Results: At 6 months, 408 [27%] vs 407 [27%]allocated rt-PA vs control had died; in survivors, mean VAS was significantly higher, indicating better HRQoL, with rt-PA (60.7 vs 57.8, mean adjusted difference 3.3, p=0.008). Across the 5 3-level domains of the EQ5D, allocation to rt-PA was associated with reduced adjusted proportional odds of having greater problems with: Self-care (odds ratio 0.79, 95% CI 0.66-0.94, p =0.008) and usual activities (0.74, 95% CI 0.63-0.88, p=0.001), but not mobility (0.88, 95% CI 0.74-1.05), anxiety depression (0.94, 95% CI 0.79-1.11) or pain or discomfort (1.01, 95% CI 0.85-1.20). The adjusted mean difference in VAS among patients randomised 0-2, 2-3, 3-4, 4-5, 5-6 hours was: 8.9, 3.5, 2.0, 0.8, 6.2. There was no difference in the proportions living in their own home 805/1058 (76%) vs 799/ 1050 (76%), nor in the proportions living in the home of a relative, in a residential home or a nursing home. Conclusion: Thrombolysis with iv rt-PA up to six hours after onset was associated with a statistically significant improvement in overall HRQoL in survivors, and the differences applied across a number of clinically significant individual domains. The decline in HRQoL(VAS) benefit with increasing time to randomisation matches the decline in benefit on functional outcome, except for the unanticipated increase at 5-6hrs.

Improvement in Wrist Pain with Ultrasound-guided Glucocorticoid Injections: A Meta-analysis of Individual Patient Data

This meta-analysis compares change in wrist pain following ultrasound-guided (US-guided) intra-articular glucocorticoid injections with change in pain after palpation-guided injections in persons with inflammatory arthritis or osteoarthritis. Data sources included MEDLINE, Cochrane, BIOSIS, CINAHL, ACR/AHRP abstracts, and ClinicalTrials.gov. Studies that assessed change in wrist pain with direct comparison of US-guided and palpation-guided injections were included in the meta-analysis. Subject-level data was sought from authors of all relevant studies. Primary outcome was mean change in wrist pain from baseline to 1-6 week follow-up by visual analog scale (VAS). Mean difference in VAS was calculated for comparative studies. Secondary outcome was proportion attaining Minimal Clinically Important Improvement (MCII), defined as VAS reduction ≥ 20%. Odds ratios (ORs) of MCII were calculated for comparative studies. Mean differences in VAS and ORs for MCII for comparative studies were combined using fixed and random effects meta-analysis. Ten studies were eligible, and adequate data was available from 4 studies with direct comparison of US-guided and palpation-guided treatment arms. The difference in mean VAS reduction (US-guided minus palpation-guided) ranged from-0.2 to 1.3, with a combined estimate of 1.0 (95% CI 0.3, 1.7). OR for MCII in comparative studies ranged from 1.0 to 12.4, with a combined OR of 3.2 (95% CI 1.2, 8.5) in favor of ultrasound. US-guided glucocorticoid injections to the wrist result in greater reductions in pain, and greater likelihood of attaining MCII than palpation-guided injections at 1-6 weeks follow-up.

Efficacy of Scapular Movement with Mobilization in Patients with Shoulder Impingement

Background & Purpose of the study: Scapular kinematic alterations have been demonstrated in subjects with impingement syndrome. These scapula movement alterations are believed to decrease the subacromial space by failing to move the acromion away from the humeral head during arm elevation resulting in increased compressive loads on the tendons of rotator cuff or long head of the biceps muscle. Mulligan's movement with mobilization (M.W.M) hypothesize that positional malalignment can be corrected with appropriate gliding. Thus this research investigates the efficacy of scapular movement with mobilization in patients with shoulder impingement. Aim: Efficacy of scapular movement with mobilization in patients with shoulder impingement Objective: Assess immediate effect of scapular movement with mobilization in shoulder impingement Research design: Exploratory study Methodology: Scapula M.W.M was given to the patient, 10 repetitions thrice were repeated. Outcome measures: Visual analogue scale was used to assess pain, Range of Motion in Scaption plane was assessed by using Goniometer, Supraspinatus strength assessment was assessed in Scaption plane, Shoulder pain and disability index (SPADI) was assessed Data collection and analysis: Baseline data recorded for the outcome measures and post intervention data was statistically analyzed for the level of significance. Paired t-test was done for the same. Results: Significant differences were observed with respect to various outcome measures studied. Visual analogue scale Mean difference is 2.880,Standard deviation difference is 1.447,95% confidence interval difference is 2.283 to 3.477,(p Conclusion: Scapular movement with mobilization proved to be effective in patients with shoulder impingement

The effect of Transcutaneous Electrical Nerve Stimulation for Pain Relief on Patient of Rib Fracture

Background: Patients with multiple rib fracture face high rates of pulmonary complications. Effective pain relief instituted early in these cases would be of immense benefit. The aim therefore was to find out the immediate effect of TENS on pain relief in patients with rib fractures. Methods: This was one time observational design, convenient sampling used, 7 consecutive patients with rib fracture were recruited from the Shree Krishna hospital, Karamsad. The patients were explained about Transcutaneous Electrical Nerve Stimulation (TENS) therapy & were given dual channel high TENS parameters for 30 minutes covering the site of pain. Before and immediately after TENS therapy, their Visual Analog Scale (VAS), Peak Expiratory Flow Rate (PEFR) & oxygen saturation (SpO2) were recorded & response was compared. Results: After data analysis the mean difference in VAS is from 6.43 to 3, which suggests that after application of TENS there is relief in pain by pain gate mechanism. There is markedly increase in PEFR from 90 to 121.43 (l/min). It reflects that patients breathing capacity is improved because of pain relief following TENS therapy. There is also increase in SpO2 level from 97.28% to 99%. Conclusions: It is concluded that TENS therapy is an effective, reliable and practical method in controlling pain and thereby improving pulmonary functions in the patients with rib fractures.

Sex Differences in Pain Scores and Localization in Inflammatory Arthritis: A Systematic Review and Metaanalysis

To systematically identify and examine reports of sex-stratified pain measurements in patients with inflammatory arthritis. Data sources included PubMed (1950 to April 2010), Embase (1980 to April 2010), and manual searches of reference lists and conference abstracts. We included cohort studies and randomized trials comparing pain scores, treatment efficacy at reducing pain, or pain localization, between females and males with inflammatory arthritis [rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, and reactive arthritis]. Twenty-six cohorts and 1 randomized trial reported sex-stratified pain scores, and all but 1 cohort identified worse pain scores at enrollment in females. In a metaanalysis of mean visual analog scale (VAS) scores (0 to 10) in 16 RA cohort studies (reporting on 21,612 females and 6871 males), the standardized mean difference in VAS was 0.21 (95% CI 0.16, 0.26). Treatment with disease-modifying therapy results in improvement in mean scores for both sexes; however, female absolute scores remain higher. In 12 spondyloarthropathy cohorts reporting pain localization, females develop more peripheral arthritis during their disease course (68.9% vs 51.2%) but less inflammatory back pain (50.6% vs 66.4%). We identified important sex differences in pain scores in inflammatory arthritis, with higher pain levels in females. In spondyloarthritis, females develop more peripheral arthritis and have less frequent spinal involvement compared to males. These differences may affect a clinician's perception of disease severity and activity, and thus influence management decisions.

Qigong and Exercise Therapy for Elderly Patients With Chronic Neck Pain (QIBANE): A Randomized Controlled Study

The aim of this study was to evaluate the effectiveness of qigong compared with exercise therapy and no treatment. Elderly patients with chronic neck pain (>6 months) were randomly assigned to qigong or exercise therapy (each 24 sessions over a period of 3 months) or to a waiting list control. Patients completed standardized questionnaires at baseline and after 3 and 6 months. The main outcome measure was average neck pain on the visual analogue scale after 3 months. Secondary outcomes were neck pain and disability (NPAD) and quality of life (SF-36). One hundred seventeen patients (age, 76 +/- 8 years, 95% women) were included in the intention-to-treat analysis. The average duration of neck pain was 19.0 +/- 14.9 years. After 3 months, no significant differences were observed between the qigong group and the waiting list control group (visual analogue scale mean difference, -11 mm [CI, -24.0; 2.1], P = .099) or between the qigong group and the exercise therapy group (-2.5 mm [ - 15.4; 10.3], P = .699). Results for the NPAD were similar (qigong vs waiting list -6.7 (-15.4; 2.1), P = .135; qigong vs exercise therapy 2.3 (-6.2; 10.8); P = .600). We found no significant effect after 3 months of qigong or exercise therapy compared with no treatment. Further studies should include outcomes more suitable to elderly patients, longer treatment, and patients with less chronic pain. In a randomized controlled study, we evaluated whether a treatment of 24 qigong sessions over a period of 3 months is (1) superior to no treatment and (2) superior to the same amount of exercise therapy in elderly patients (age, 76 +/- 8 years, 95% women) with long-term chronic neck pain (19.0 +/- 14.9 years). After 3 and 6 months, we found no significant differences for pain, neck pain, disability, and quality of life among the 3 groups.

Value of Culdocentesis

<h3>Background</h3> Community pharmacists are well positioned to support patients’ minor ailments. The objective was to evaluate the clinical and humanistic impact of a minor ailment service (MAS) in community pharmacy compared with usual pharmacist care (UC). <h3>Methods</h3> A cluster randomised controlled trial was conducted. Intervention patients received MAS, which included a consultation with the pharmacist. MAS pharmacists were trained in clinical pathways and communication systems mutually agreed with general practitioners and received monthly support. Control patients received UC. All patients were followed up by telephone at 14 days. Clinical and humanistic impact were defined by primary (appropriate referral rate and appropriate non-prescription medicine rate) and secondary outcomes (clinical product-based intervention rate, referral adherence, symptom resolution, reconsultation and EuroQol EQ-5D visual analogue scale (VAS)). <h3>Results</h3> Patients (n=894) were recruited from 30 pharmacies and 82% (n=732) responded to follow-up. Patients receiving MAS were 1.5 times more likely to receive an appropriate referral (relative rate (RR)=1.51; 95% CI 1.07 to 2.11; p=0.018) and were five times more likely to adhere to referral, compared with UC (RR=5.08; 95%CI 2.02 to 12.79; p=0.001). MAS patients (94%) achieved symptom resolution or relief at follow-up, while this was 88% with UC (RR=1.06; 95% CI 1 to 1.13; p=0.035). MAS pharmacists were 1.2 times more likely to recommend an appropriate medicine (RR 1.20, 95% CI 1.1 to 1.3; p=0.000) and were 2.6 times more likely to perform a clinical product-based intervention (RR=2.62, 95% CI 1.28 to 5.38; p=0.009), compared with UC. MAS patients had a greater mean difference in VAS at follow-up (4.08; 95% CI 1.23 to 6.87; p=0.004). No difference in reconsultation was observed (RR=0.98; 95% CI 0.75 to 1.28; p=0.89). <h3>Conclusion</h3> The study demonstrates improved clinical and humanistic outcomes with MAS. National implementation is a means to manage minor ailments more effectively in the Australian health system. <h3>Trial registration number</h3> ACTRN12618000286246.