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Optimal case definitions of upper extremity disorder for use in the clinical treatment and referral of patients

Optimal case definitions of upper extremity disorder for use in the clinical treatment and referral of patients
Optimal case definitions of upper extremity disorder for use in the clinical treatment and referral of patients
Objective: Experts disagree about the optimal classification of upper extremity disorders. To explore whether differential response to treatments offers a basis for choosing between case definitions, we analyzed previously published research.

Methods: We screened 183 randomized controlled trials (RCTs) of treatments for upper extremity disorders identified from the bibliographies of 10 Cochrane reviews and 4 other systematic reviews, and a search in Medline, Embase, and Google Scholar to June 2010. From these, we selected RCTs that allowed estimates of benefit (expressed as relative risks [RRs]) for >1 case definition to be compared when other variables (treatment, comparison group, followup time, outcome measure) were effectively held constant. Comparisons of RRs for paired case definitions were summarized by their ratios, with the RR for the simpler and broader definition as the denominator.

Results: Two RCT reports allowed within-trial comparison of RRs and 13 others allowed between-trial comparisons. Together these provided 17 ratios of RRs (5 for shoulder treatments, 12 for elbow treatments, and none for wrist/hand treatments). The median ratio of RRs was 1.0 (range 0.3–1.7, interquartile range 0.6–1.3).

Conclusion: Although the evidence base is limited, our findings suggest that for musculoskeletal disorders of the shoulder and elbow, clinicians in primary care will often do best to apply simpler and broader case definitions. Researchers should routinely publish secondary analyses for subgroups of patients by different diagnostic features at trial entry to expand the evidence base on optimal case definitions for patient management.
0004-3591
573-580
Palmer, K.T.
0cfe63f0-1d33-40ff-ae8c-6c33601df850
Harris, E.C.
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Linaker, C.
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Ntani, G.
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Cooper, C.
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Coggon, D.
2b43ce0a-cc61-4d86-b15d-794208ffa5d3
Palmer, K.T.
0cfe63f0-1d33-40ff-ae8c-6c33601df850
Harris, E.C.
3e4bd946-3f09-45a1-8725-d35e80dd7971
Linaker, C.
6c6d1b90-ee40-4c96-8b2e-b06efbe030ae
Ntani, G.
9b009e0a-5ab2-4c6e-a9fd-15a601e92be5
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Coggon, D.
2b43ce0a-cc61-4d86-b15d-794208ffa5d3

Palmer, K.T., Harris, E.C., Linaker, C., Ntani, G., Cooper, C. and Coggon, D. (2012) Optimal case definitions of upper extremity disorder for use in the clinical treatment and referral of patients. Arthritis & Rheumatism, 64 (4), 573-580. (doi:10.1002/acr.21588). (PMID:22213545)

Record type: Article

Abstract

Objective: Experts disagree about the optimal classification of upper extremity disorders. To explore whether differential response to treatments offers a basis for choosing between case definitions, we analyzed previously published research.

Methods: We screened 183 randomized controlled trials (RCTs) of treatments for upper extremity disorders identified from the bibliographies of 10 Cochrane reviews and 4 other systematic reviews, and a search in Medline, Embase, and Google Scholar to June 2010. From these, we selected RCTs that allowed estimates of benefit (expressed as relative risks [RRs]) for >1 case definition to be compared when other variables (treatment, comparison group, followup time, outcome measure) were effectively held constant. Comparisons of RRs for paired case definitions were summarized by their ratios, with the RR for the simpler and broader definition as the denominator.

Results: Two RCT reports allowed within-trial comparison of RRs and 13 others allowed between-trial comparisons. Together these provided 17 ratios of RRs (5 for shoulder treatments, 12 for elbow treatments, and none for wrist/hand treatments). The median ratio of RRs was 1.0 (range 0.3–1.7, interquartile range 0.6–1.3).

Conclusion: Although the evidence base is limited, our findings suggest that for musculoskeletal disorders of the shoulder and elbow, clinicians in primary care will often do best to apply simpler and broader case definitions. Researchers should routinely publish secondary analyses for subgroups of patients by different diagnostic features at trial entry to expand the evidence base on optimal case definitions for patient management.

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e-pub ahead of print date: 27 March 2012
Published date: April 2012
Organisations: Faculty of Health Sciences

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Local EPrints ID: 340512
URI: http://eprints.soton.ac.uk/id/eprint/340512
ISSN: 0004-3591
PURE UUID: 291f18ae-c030-4863-af16-e6b313201bbc
ORCID for E.C. Harris: ORCID iD orcid.org/0000-0001-8037-566X
ORCID for C. Linaker: ORCID iD orcid.org/0000-0003-1091-9283
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for D. Coggon: ORCID iD orcid.org/0000-0003-1930-3987

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Date deposited: 25 Jun 2012 09:14
Last modified: 18 Mar 2024 02:45

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Contributors

Author: K.T. Palmer
Author: E.C. Harris ORCID iD
Author: C. Linaker ORCID iD
Author: G. Ntani
Author: C. Cooper ORCID iD
Author: D. Coggon ORCID iD

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