Post 24: 24 March 2006
Links are given to online full text resources, all other materials can be obtained via the Fade Library, just mail your request to library.services@fade.nhs.uk
Latest Systematic Reviews
Latest Guidelines
Latest Reports
Evidence from Journals
Latest Questions to the Primary Care Question Answering Service
Hitting the Headlines - Evidence Behind the Press Stories
Document of the Week from the National Library for Health
Latest Systematic Reviews
Bias in published cost effectiveness studies: systematic review
Chaim M Bell, David R Urbach, Joel G Ray, Ahmed Bayoumi, Allison B Rosen, Dan Greenberg, Peter J Neumann
BMJ 2006;332:699-703, doi:10.1136/bmj.38737.607558.80
Objective To investigate if published studies tend to report favourable cost effectiveness ratios (below $20 000, $50 000, and $100 000 per quality adjusted life year (QALY) gained) and evaluate study characteristics associated with this phenomenon.
Design Systematic review.
Studies reviewed 494 English language studies measuring health effects in QALYs published up to December 2001 identified using Medline, HealthSTAR, CancerLit, Current Content, and EconLit databases.
Main outcome measures Incremental cost effectiveness ratios measured in dollars set to the year of publication.
Results Approximately half the reported incremental cost effectiveness ratios (712 of 1433) were below $20 000/QALY. Studies funded by industry were more likely to report cost effectiveness ratios below $20 000/QALY (adjusted odds ratio 2.1, 95% confidence interval 1.3 to 3.3), $50 000/QALY (3.2, 1.8 to 5.7), and $100 000/QALY (3.3, 1.6 to 6.8). Studies of higher methodological quality (adjusted odds ratio 0.58, 0.37 to 0.91) and those conducted in Europe (0.59, 0.33 to 1.1) and the United States (0.44, 0.26 to 0.76) rather than elsewhere were less likely to report ratios below $20 000/QALY.
Conclusion Most published analyses report favourable incremental cost effectiveness ratios. Studies funded by industry were more likely to report ratios below the three thresholds. Studies of higher methodological quality and those conducted in Europe and the US rather than elsewhere were less likely to report ratios below $20 000/QALY
Latest Guidelines
Irritable bowel syndrome in adults: prevention, diagnosis and management of irritable bowel syndrome in primary care
NICE has issued a draft scope on “Irritable bowel syndrome in adults: prevention, diagnosis and management of irritable bowel syndrome in primary care” for consultation
In terms of clinical management, areas that will be covered are:
• Diagnosis of IBS in primary care. This will include patient history, clinical examination and diagnostic tests using the ROME II criteria.
• Patient self-management, including exercise and dietary changes, and self-medication.
• Drug treatments, including bulking agents, anti-motility agents, antispasmodics and anti-depressants. Note that guideline recommendations will normally fall within licensed indications; exceptionally, and only where clearly supported by evidence, use outside of a licensed indication may be recommended. The guideline will assume that prescribers will use the Summary of Product Characteristics to inform their decisions for individual patients.
• Non-pharmacological treatments, including a range of therapeutic treatments such as cognitive behavioural therapy, acupuncture, Chinese herbal medicine, hypnotherapy, meditation, reflexology and aromatherapy.
The development of the guideline recommendations will begin in May 2006.
Tuburculosis: Clinical diagnosis and management of tuberculosis, and measures for its prevention and control
NICE has published guidelines on clinical diagnosis and management of tuberculosis, and measures for its prevention and control. The clinical guideline covers:
• diagnosing and treating active and latent TB in adults and children
• preventing the spread of TB, for example by offering tests to people at high risk, and by vaccination.
• the guideline does not explain TB or its treatments in detail.
In terms of the management of active TB, the following recommendations have been identified as priorities for implementation (taken directly from the guideline):
• A 6-month, four-drug initial regimen (6 months of isoniazid and rifampicin supplemented in the first 2 months with pyrazinamide and ethambutol) should be used to treat active respiratory TB in:
- adults not known to be HIV-positive
- adults who are HIV-positive
- children.
• Patients with active meningeal TB should be offered:
- a treatment regimen, initially lasting for 12 months, comprising isoniazid,
pyrazinamide, rifampicin and a fourth drug (for example, ethambutol) for the first 2 months, followed by isoniazid and rifampicin for the rest of the treatment period
- a glucocorticoid at the normal dose range: adults – equivalent to prednisolone 20–40mg if on rifampicin, otherwise 10–20 mg; children - equivalent to prednisolone 1–2 mg/kg, maximum 40mg with gradual withdrawal of the glucocorticoid considered, starting within 2–3 weeks of initiation.
Final Appraisal Determination (FAD) on erythropoietin for anaemia induced by cancer treatment.
NICE has issued a Final Appraisal Determination (FAD) on erythropoietin for anaemia induced by cancer treatment.
The guidance does not cover the use of erythropoietin (epoetin alfa, epoetin beta and darbepoetin alfa) in the management of cancer-related anaemia that is not induced by cancer treatment (chemotherapy or radiotherapy). The preliminary recommendations are as follows:
• Erythropoietin is recommended for use in the management of anaemia only as part of ongoing or new clinical trials that are constructed to generate robust and relevant data in order to address the gaps in the currently available evidence.
• Patients currently receiving erythropoietin could experience loss of well-being if treatment is discontinued at a time they did not anticipate. Because of this, patients should have the option to continue therapy until they and their consultants consider it appropriate to stop.
The appeal period for this appraisal will close on 31 March 2006.
Improving outcomes for people with sarcoma
The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Cancer (NCCC) have issued guidance for the NHS in England and Wales on how to improve the care of all patients with bone sarcomas and adults with soft tissue sarcomas. The guidance provides advice to those who develop and deliver cancer services on the planning, commissioning and configuration of those services.
Improving Outcomes for People with Skin Tumours including Melanoma
The NICE clinical guideline on skin tumours outlines how healthcare services for people with skin tumours should be organised. The key recommendations are:
- Cancer networks should establish two levels of multidisciplinary teams to care for patients. - Patients with a precancerous lesion should either be treated by their GP or referred. - The care of patients with low-risk basal cell carcinoma may be managed by doctors in the community or at a local hospital. - Patients who need specialist diagnosis should be referred to a doctor trained to diagnose skin cancer. - Skin cancer teams should work to agreed protocols. - Protocols should cover the management of care for people in high-risk or special groups. - Follow-up care should be agreed. - All patients and carers should have access to high quality information. - Information should be collected. - More research should be done.
Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition
The NICE clinical guideline on nutrition support in adults covers the care of patients with malnutrition or at risk of malnutrition, whether they are in hospital or at home. It doesn't cover malnutrition or its treatments in detail.
Latest Reports
Moving beyond effectiveness in evidence synthesis: Methodological issues in the synthesis of diverse sources of evidence
Popay J
National Institute for Health and Clinical Excellence
Imprint: London : NICE, 2006
120p.
Between 2000 and 2005 the Health Development Agency (HDA) carried out a programme of work to develop the evidence base in public health. As part of that work there was an underpinning methodological workstream. The contents of this volume arose from one of the activities within that workstream. In 2003 a group of researchers and methodologists held a seminar to consider the question of evidence synthesis when that evidence is derived from diverse sources and from a variety of methodological traditions. This document consists of reworked versions of the papers presented at that meeting.
Essence of care: promoting health
Department of Health
Imprint: London : DoH, 2006
14p.
Essence of care: promoting health is a new benchmark that provides a framework for shifting the focus from treating ill health to the promotion of healthier life choices in all good patient care. The benchmarking process outlined in the 2003 edition of Essence of care helps practitioners to take a structured approach to sharing and comparing practice, enabling them to identify the best examples and to develop action plans to remedy poor practice.
Independent Advisory Group on Sexual Health and HIV: Annual repoort 2004/2005
Gould J
Independent Advisory Group on Sexual Health and HIV
Imprint: London : DoH, 2005
32p.
The third annual report of the Independent Advisory Group on Sexual Health and HIV made recommendations in four main areas: delivering improved services; developing new services; enhancing professional skills; and promoting sexual health and wellbeing in the 21st century.
Independent Advisory Group on Sexual Health and HIV: DH response to the third annual report published October 2005: 15 March 2006
Department of Health
Imprint: London : DoH, 2006
5p.
NHS foundation trusts: nine-month report for period 1 April 2005 to 31 December 2005
Monitor
Imprint: London : Monitor, 2006
4p.
Monitor has published NHS foundation trusts: nine-month report for period 1 April 2005 to 31 December 2005 together with a technical annex, which outlines the financial performance of the 32 FTs between April and December 2005. Some of the main findings are:
The aggregate deficit of the 32 FTs was £9m on total income of £5,000m;
Excluding the performance of one FT (University College London Hospitals), the remaining 31 FTs generated a £20m surplus, considerably ahead of their planned position of an £11m surplus;
The performance of University College London Hospitals (UCLH) NHS FT remains a significant concern. At quarter 3 it had a deficit of £29.4m (quarter 2 £17.4m). The Board of UCLH, overseen by Monitor, is implementing a detailed plan for financial recovery. The Board of UCLH has been invited to present its recovery plan at a meeting with the Board of Monitor on 15 March;
Three FTs which recorded significant net deficits in 2004/05 (Bradford, Peterborough and Royal Devon & Exeter) have been implementing turnaround plans, with the support of Monitor. The 2004/05 aggregate deficit of £23m has been reduced to £0.4m at quarter 3. Bradford has now reverted to quarterly, rather than monthly, monitoring;
Performance in quarter 4 may not be as strong as in the nine months to quarter 3. A number of FTs are reporting concerns about the ability and willingness of PCTs to pay for contracted activity. It is possible FTs will be forced to make provision for potential non-payment for some activity, resulting in a weaker full-year position.
Creating the future: Modernising careers for salaried dentists in primary care: Stakeholder consultation: Response report
NHS Partners
Imprint: London : DoH, 2006
49p.
This is the outcome of the consultation on modernising careers for salaried dentists in England. 'Creating the future: modernising careers for salaried dentists in primary care: stakeholder consultation: response report' provides an analysis of consultation responses, key findings, participant profile and an analysis of quantitative data. The Department of Health has also published its response to the consultation.
Creating the future: Modernising careers for salaried dentists in primary care: Department of Health response
Department of Health
Imprint: London : DoH, 2006
3p.
This is the response the consultation on modernising careers for salaried dentists in England, 'Creating the future: modernising careers for salaried dentists in primary care: stakeholder consultation: response report'.
Learning from the Implementation Co-ordination Group
Primary Care Contracting
Imprint: London : Primary Care Contracting, 2006
8p.
The Implementation Coordination Group (ICG) was first established as an interim arrangement to deal with problems during the implementation phase of the new GMS contract. It was re-established in response to calls from LMCs for involvement from the GPC and the Department of Health in local disagreements with PCOs that could not be resolved locally and which were inappropriate for formal dispute resolution procedures. The ICG meets monthly and comprises of a negotiator from the three National negotiating parties – Richard Armstrong (Department of Health), Philip Grant (NHS Employers Organisation) and Hamish Meldrum (GPC). The ICG deals with both local and national problems arising from the interpretation of the GMS contract regulations and guidance and provides a final recommendation on matters raised.
This document shares learning from recent decisions to allow learning from these cases across the wider NHS.
Getting equal: Proposals to outlaw sexual orientation discrimination in the provision of goods and services
Walker F
Department of Trade and Industry
Imprint: London : DTI, 2006
84p.
The Equality Act 2006 included a power that allows the Government to prohibit discrimination on the grounds of sexual orientation in the provision of goods, facilities and services, in education and in the exercise of public functions. The Government intends to use this power to make regulations that take effect in October 2006. This consultation paper describes the approach proposed for the regulations. They are intended to bring protection from sexual orientation discrimination into line with existing legislation that prohibits discrimination on the grounds of race, sex and for reasons related to disability.
Survey of employers’ policies, practices and preferences relating to age: A report of research carried out by the National Institute of Economic and Social Research (NIESR) in conjunction with the British Market Research Bureau (BMRB) on behalf of the Department for Work and Pensions and the Department of Trade and Industry
Metcalf H
Co-Meadows P
National Institute of Economic and Social Research; British Market Research Bureau
Imprint: DWP, 2006
240p.
Series: (Research Report No 325: DTI Employment Relations Research Series No 49)
This survey was designed to establish, prior to the implementation of the Employment Equality (Age) Regulations 2006, the extent to which current employment policies and practices have an age dimension. It provides a baseline measure for evaluating the effectiveness of the regulations. The study was based on a representative survey of 2,087 employment establishments in Great Britain with at least five employees.
New deal for disabled people evaluation: Survey of eligible population, wave three
Pires R
Co-Kazimirski A; Shaw A; Sainsbury R; Meah A
National Centre for Social Research; Social Policy Research Unit
Imprint: London : DWP, 2006
140p.
Series: (Research Report No 324)
The New Deal for Disabled People (NDDP) is the major employment programme for people on incapacity benefits. It is a voluntary programme that aims to help people with a disability or health condition move into sustained employment. Over 65 job brokers, who are a mix of public, private and voluntary sector organisations, have delivered the programme. As part of a comprehensive evaluation, the survey of the eligible population has been conducted to obtain information about people who were eligible and invited to take part in NDDP. The survey aims to establish the characteristics of this population, their work aspirations and their awareness of, attitudes to and involvement with NDDP.
Choice of scan: Phase 2: Guidance
Department of Health
Imprint: London : DoH, 2006
10p.
The Department of Health has published updated guidance for phase 2 of the Choice of Scan initiative. Choice of Scan: phase 2 - guidance has been developed with NHS stakeholders at trust, PCT and SHA levels. From April 2006, Choice of Scan, phase 2 will go live. This will mean that hospitals will offer patients waiting longer for all diagnostic imaging tests who do not have an appointment within 20 weeks, the choice of having their scan at another provider within a maximum of 20 weeks from their original referral.
National survey of NHS staff 2005: Summary of key findings
Healthcare Commission
Imprint: London : Healthcare Commission, 2006
39p.
The annual NHS staff survey has been published by the Healthcare Commission. The Commission states that the survey shows the first significant sign of a trend towards fewer staff facing physical attacks, bullying and harassment from patients or their relatives. 28% of respondents said they had experienced either violence or abuse in the previous 12 months, compared with 31% in 2004 and 32% in 2003. But the Commission said it was too early to say whether the trend would carry on and urged NHS trusts to continue their efforts to tackle the problem.
On errors and incidents, 40% of respondents reported seeing at least one potentially harmful error, near miss or incident that could have hurt either staff or patients in the previous month . However, this is a fall from 47% in 2003.
The survey suggests that trusts could do more to reduce the spread of hospital-acquired infection. One in four staff said that their trust does not do enough to promote the importance of hand cleaning to staff, patients and visitors. Only 61% reported that hot water, soap and paper towels, and alcohol rubs were always available when needed. But a further 28% did report that they were available most of the time.
The survey also suggests that NHS employment is becoming more family friendly. Thirty-eight per cent of staff reported access to a childcare co-ordinator in 2005 compared to 32% in 2003. Staff reporting access to subsidised childcare also increased from 17% to 24% over the three years.
The survey also covers areas such as whistle-blowing, work-related stress and equal opportunities
Department of Health draft simplification plan
Department of Health
Imprint: London : DoH, 2006
3p.
The Department of Health has published a draft plan setting out its commitment to reduce policy and administrative costs by more than £750 million. This responds to the requirement set by Government following the Better Regulation Task Force report, Less is More, to develop a rolling simplification plan.
The draft plan includes:
the reconfiguration of DH's arms length bodies
the wider review of health and social care regulations aiming to balance patient safety with reducing administrative burdens,
and initiatives being introduced to streamline data gathering and dissemination and reduce bureaucracy on the NHS.
Accessibility planning and the NHS: Improving patient access to health services
National Institute of Health and Clinical Excellence
Imprint: London : NICE, 2006
16p.
This briefing provides an overview of accessibility planning, highlights the role of the NHS and describes some examples of current approaches. It is aimed at:
NHS managers and board members dealing with service reconfiguration, the location of services, the Local Improvement Finance Trust (LIFT), and health service planning in general
Local authority transport planning and health policy officers and elected members, especially those concerned with the health aspects of accessibility planning and the local transport plan process
Practitioners working to reduce health inequalities and/or enhance social cohesion and inclusion.
Evidence from Journals
Bischoff-Ferrari HA, et al. Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Arch Intern Med. 2006 Feb 27;166(4):424-30
BACKGROUND: A recent meta-analysis found that cholecalciferol (vitamin D) should reduce falls by more than 20%. However, little is known about whether supplemental cholecalciferol plus calcium citrate malate will lower the long-term risk of falling in men, active older individuals, and older individuals with higher 25-hydroxyvitamin D levels.
METHODS: We studied the effect of 3-year supplementation with cholecalciferol-calcium on the risk of falling at least once in 199 men and 246 women 65 years or older and living at home. Individuals received 700 IU of cholecalciferol plus 500 mg of calcium citrate malate per day or placebo in a randomized double-blind manner. Subjects were classified as less physically active if physical activity was below the median level. Low 25-hydroxyvitamin D levels were classified as those below 32 ng/mL (<80 style="font-weight: bold;">RESULTS: In 3 years, 55% of women and 45% of men reported at least 1 fall. Mean +/- SD baseline 25-hydroxyvitamin D levels were 26.6 +/- 12.7 ng/mL (66.4 +/- 31.7 nmol/L) in women and 33.2 +/- 14.2 ng/mL (82.9 +/- 34.9) in men. Cholecalciferol-calcium significantly reduced the odds of falling in women (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.30-0.97), but not in men (OR, 0.93; 95% CI, 0.50-1.72). Fall reduction was most pronounced in less active women (OR, 0.35; 95% CI, 0.15-0.81). Baseline 25-hydroxyvitamin D level did not modulate the treatment effect.
CONCLUSIONS: Long-term dietary cholecalciferol-calcium supplementation reduces the odds of falling in ambulatory older women by 46%, and especially in less active women by 65%. Supplementation had a neutral effect in men independent of their physical activity level.
Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study
Murna Downs, Stephen Turner, Michelle Bryans, Jane Wilcock, John Keady, Enid Levin, Ronan O'Carroll, Kate Howie, Steve Iliffe
BMJ 2006;332:692-696, doi:10.1136/bmj.332.7543.692
Objective To test the effectiveness of educational interventions in improving detection rates and management of dementia in primary care.
Design Unblinded, cluster randomised, before and after controlled study.
Setting General practices in the United Kingdom (central Scotland and London) between 1999 and 2002.
Interventions Three educational interventions: an electronic tutorial carried on a CD Rom; decision support software built into the electronic medical record; and practice based workshops.
Participants 36 practices participated in the study. Eight practices were randomly assigned to the electronic tutorial; eight to decision support software; 10 to practice based workshops; and 10 to control. Electronic and manual searches yielded 450 valid and usable medical records.
Main outcome measures Rates of detection of dementia and the extent to which medical records showed evidence of improved concordance with guidelines regarding diagnosis and management.
Results Decision support software (P = 0.01) and practice based workshops (P = 0.01) both significantly improved rates of detection compared with control. There were no significant differences by intervention in the measures of concordance with guidelines.
Conclusions Decision support systems and practice based workshops are effective educational approaches in improving detection rates in dementia.
Therapeutics
The Bug Buster kit was better than single dose pediculicides for head lice
Dawes
Evid Based Med.2006; 11: 17
Pulmonary vein isolation was better than antiarrhythmic drugs for symptomatic atrial...
George Wyse
Evid Based Med.2006; 11: 16
Vitamin E did not prevent cardiovascular disease and cancer in healthy women
Rees Willett
Evid Based Med.2006; 11: 11
Using exhaled NO concentrations to adjust inhaled corticosteroid dose maintained...
Rees
Evid Based Med.2006; 11: 20
Review: viscosupplementation for knee osteoarthritis reduces pain and improves function
Shoor
Evid Based Med.2006; 11: 12
Review: vitamin D plus calcium, but not vitamin D alone, prevents osteoporotic fractures...
Johnell
Evid Based Med.2006; 11: 13
Low dose aspirin did not prevent cancer in healthy women
Cook NR
Evid Based Med. 2006;11:10
Diagnosis
Review: IgA endomyseal and transglutaminase antibodies had high specificity for...
Gibson
Evid Based Med.2006; 11: 25
EBM Notebook
An emerging consensus on grading recommendations?
Guyatt et al.
Evid Based Med.2006; 11: 2-4
Latest Questions to the Primary Care Question Answering Service
Assessment and Diagnosis
Can you recommend an assessment tool or depression scale for the assessment of severity of depression?
What were the main findings of the million women's health study?
Please could you let me know if it is better to clean a wound before taking a swab for culture and sensitivity - and the rational behind it - thank you
I’ve heard about a new medical encyclopaedia that doctors can edit – any ideas?
Cancer
In the treatment of ganglions, what is the evidence for different treatment methods? In particular, how does aspiration compare with surgical excision?
Cardiovascular disease
Is there any available patient information for children/young adults with precordial catch?
What extra degree of protection from further cardiovascular events is gained by reducing total cholesterol target from 5 mmol/L to 4 mmol/L for a population receiving sec prevention management after a CV event
In patient with PH of IHD and recent episode fast AF, what is evidence base for adding Clopidogrel to Aspirin antiplatelet therapy?
Causes Risks and Prevention
In a patient taking stontium for osteoporosis is their a link with memory loss and fits?
What is the safest antidepressant to use in pregnancy at 22 weeks?
Infectious disease
If you have a IUD user with suspected chlamydia, who you plan to treat, would you remove the IUD?
Obesity
Is there any evidence that metformin causes weight loss in non diabetic patients
Palliative care
What standards or good practice guidelines are there for terminal care/end of life care in cottage hospitals? I am particularly interested around privacy and dignity issues.
Renal & urogenital
What is the best treatment for persistant hyponatraemia in an elderly woman?
Hitting the Headlines - Evidence Behind the Press Stories
'Spinal manipulation doesn't work'
There is no evidence that spinal manipulation works, reported three newspapers on 22 March 2006. The newspaper articles are based on a systematic review of systematic reviews. Insufficient outcome data, uncertain methodology of the included reviews, and uncertain quality of the original studies limits interpretation.
Three newspapers (1-3) reported that there was no evidence that spinal manipulation works, although one newspaper (1) noted that spinal manipulation was as effective as conventional treatments for the relief of back pain. In addition, two of the newspapers (1,2) reported that spinal manipulation was associated with minor adverse events, and more rarely with serious complications.
The newspaper articles are based on a systematic review (4) of sixteen systematic reviews concerned with spinal manipulation for any medical condition. The review concluded that there is no evidence that spinal manipulation is effective for any condition, except back pain, where it is no better than conventional treatment.
The main message from the research that there is little evidence to support the practice of spinal manipulation was correctly reflected in all the newspapers. No data on adverse events were presented in the review, although an association was referred to in the press release (5) and in the authors' conclusions. The uncertain methodology of the original reviews and uncertain quality of the original studies makes it difficult to judge the validity of the authors' conclusions.
Evaluation of the evidence base for spinal manipulation for any medical condition
Where does the evidence come from?
The research was led by Professor Edzard Ernst, based at the Penisular Medical School, Exeter, UK.
What were the authors' objectives?
To determine the effectiveness of spinal manipulation for any medical problem.
What was the nature of the evidence?
The study was a systematic review of sixteen systematic reviews published between 2000 and May 2005. A total of 239 studies, assessing spinal manipulation in a variety of medical conditions (back pain, neck pain, non-spinal pain, primary and secondary dysmenorroea, infantile colic, asthma, allergy, cervicogenic dizziness, and any medical problem) were included. Four electronic databases were used to identify relevant systematic reviews, unrestricted by language. Reviews were required to have explicit and repeatable search strategies, inclusion and exclusion criteria, as well as include evidence from at least two controlled trials to be eligible for inclusion.
What interventions were examined in the research?
The reviews included any type of spinal manipulation, spinal manipulation and mobilization, chiropractic spinal manipulation, physiotherapy and/or spinal manipulation, or manual therapy.
What were the findings?
The authors presented excerpts from the conclusions made in each of the included studies. The majority of the reviews concluded that there was no evidence that spinal manipulation is effective, or that spinal manipulation is more effective than other treatments. However, one review showed that spinal manipulation is better than sham therapy for low back pain, and another concluded that when combined with exercise, spinal manipulation can be effective in reducing back pain, but is not as effective as a single treatment. Another review concluded that spinal manipulation is better than massage, and produces an effect similar to that of prophylactic drugs for headache, and another concluded that spinal manipulation and/or mobilisation are possible treatment options for low back and neck pain. None of the reviews found conclusive evidence that spinal manipulation is ineffective.
What were the authors' conclusions?
The authors concluded that there is no evidence that spinal manipulation is effective for any of the conditions examined, except for back pain where it was superior to sham manipulation but no better than conventional treatment. The authors state that, given the possibility of adverse effects, the review does not support the use of spinal manipulation.
How reliable are the conclusions?
While this systematic review appears to have been well conducted, insufficient details of the methodological robustness of the reviews included in the systematic review were provided. In addition, few details relating to the quality or the results of the primary studies included in the original reviews were reported. As a consequence, the reliability of the authors' conclusions cannot be fully assessed.
Systematic reviews
Information staff at CRD searched for systematic reviews relevant to this topic. Systematic reviews are valuable sources of evidence as they locate, appraise and synthesize all available evidence on a particular topic.
There was one related systematic review identified on the Cochrane Database of Systematic Reviews (CDSR) (5). There were three related reviews identified on the Database of Abstracts of Reviews of Effects (DARE) (6-8).
References and resources
1. Chiropractors are offering 'worthless' form of treatment. The Times, 22 March 2006, p11.
2. Back treatments 'that cause more harm than good'. Daily Mail, 22 March 2006, p19.
3. Quack-ache. The Sun, 22 March 2006, p13.
6. Ernst E. Massage therapy for low back pain: a systematic review. Journal of Pain and Symptom Management 1999;17(1):65-69. [DARE Abstract]
7. Koes B W, Assendelft W J, van der Heijden G J, Bouter L M. Spinal manipulation for low back pain: an updated systematic review of randomized clinical trials. Spine 1996;21(24):2860-2871. [DARE Abstract]
8. Evans G, Richards S. Low back pain: an evaluation of therapeutic interventions. Bristol: University of Bristol, Department of Social Medicine, Health Care Evaluation Unit 1996:176. [DARE Abstract]
Consumer information
British Chiropractic Association
NHS Direct - Complementary therapies
Previous Hitting the Headlines summaries on this topic
Can chiropractic maim and kill? Hitting the Headlines archive, 12th July 2001.Document of the Week from the National Library for Health
"Better reporting of harms in randomized trials: an extension of the CONSORT statement."
Annals of Internal Medicine present the CONSORT checklist with 10 new recommendations about how to report issues relating to harm.
The authors of this paper also include examples or proper reporting.
posted by Kieran at 7:50 am
0 comments
