Best practice & research. Clinical rheumatology
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Best Pract Res Clin Rheumatol · Dec 2005
ReviewHow many people develop fractures with what outcome?
Osteoporosis is an important clinical and public health problem because of its association with fractures. Osteoporotic fractures result in significant morbidity, mortality and health and social care costs. ⋯ Over and above this demographic trend there is evidence that the age-specific rates of fractures have increased during the last century. This chapter reviews the epidemiology of osteoporotic fractures, including their occurrence, descriptive epidemiology and impact.
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Best Pract Res Clin Rheumatol · Dec 2005
ReviewIn whom and how to prevent glucocorticoid-induced osteoporosis.
Glucocorticoid use is widespread in medicine. While it is often life-saving, side-effects are well known. ⋯ Today we have therapies with proven efficacy for the prevention of vertebral fractures and bone loss. Consequently recognition of glucocorticoid-induced osteoporosis is extremely important given the availability of effective therapy.
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Best Pract Res Clin Rheumatol · Aug 2005
Review Comparative StudyTrend in methodological quality of randomised clinical trials in low back pain.
During the past decades, the number of published randomised clinical trials evaluating the efficacy of conservative treatments for low back pain has substantially increased. At the same time several initiatives were undertaken in order to improve the methodological quality of published randomised clinical trials, also in the field of low back pain. We investigated how the methodological quality of randomised clinical trials in the field of low back pain developed over time since the first published trial in 1961. ⋯ The median overall quality scores ranged from 36 to 82% depending on the type of intervention. There were no improvements in median overall methodological quality over time from 1960 to 2004. Improvements were apparent for a few validity criteria only.
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Four important domains directly related to low back pain are: pain intensity, low-back-pain-specific disability, patient satisfaction with treatment outcome, and work disability. Within each of the domains, different questionnaires have been proposed. This chapter focuses on validated and widely used questionnaires. ⋯ For global perceived effect, we argue that the MCIC is most appropriately defined in terms of at least 'much improved' or 'very satisfied', instead of including 'slightly improved'. Finally, we argue that, from the point of view of cost effectiveness, every day of earlier return to work is important. The exact value for the MCIC can be determined, taking into account the aim of the measurement, the initial scores, the target population and the method used to assess MCIC.
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The choice of medication for low back pain should be evidence based and tailored as much as possible to suit the individual patient. Acetaminophen (paracetamol), mild opioids and NSAIDs are the first-line drugs for low back pain but there is no evidence that one is more effective than the others. ⋯ The realization that symptoms other than pain are sometimes more important and/or easier to overcome can increase the benefits of medication. The long-term effects of medication can be improved when it is combined with non-drug interventions.