All current clinical practice guidelines for the management of acute low back pain (LBP) agree that acute LBP has an excellent prognosis with most cases recovering within 4-6 weeks. However, the information on prognosis is contradictory and in fact chronic low back pain could develop in as many as 56% of those with acute low back pain. There is also agreement among the guidelines that the rare cases of serious disease (eg cancer) can be detected with a routine clinical examination but no study h ....All current clinical practice guidelines for the management of acute low back pain (LBP) agree that acute LBP has an excellent prognosis with most cases recovering within 4-6 weeks. However, the information on prognosis is contradictory and in fact chronic low back pain could develop in as many as 56% of those with acute low back pain. There is also agreement among the guidelines that the rare cases of serious disease (eg cancer) can be detected with a routine clinical examination but no study has evaluated the accuracy of the complete clinical assessment, and there is only limited evidence on components of the clinical assessment. We will therefore investigate the 1 year prognosis of LBP and the accuracy of the clinical assessment for detecting serious disease in the back pain population. Our study will provide the first reliable estimates of prognosis of acute LBP and the accuracy of widely recommended clinical assessment procedures and thereby allow appropriate allocation of funds to this enormous problem.Read moreRead less
The First Placebo-controlled Trial Of Paracetamol For Back Pain.
Funder
National Health and Medical Research Council
Funding Amount
$626,021.00
Summary
Each year in Australia over $1Billion is spent on treatments for low back pain. An important approach to solving this problem is to evaluate back pain treatments that are readily available, safe, cheap and effective. Our previous work suggests that regular paracetamol may be such a treatment. We propose to conduct the first ever placebo controlled trial of paracetamol for acute low back pain in a large clinical trial.
Implementing Clinical Practice Guidelines In General Practice: A Cluster Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$426,000.00
Summary
Evidence based clinical practice guidelines have the potential to improve clinical practice through providing health care workers with the most reliable information on which to base their treatment decisions. Many governments and organisations are investing significantly in the development of guidelines for common and important clinical disorders. To date, however, we do not fully understand how to increase the uptake of guidelines and facilitate health care workers to change their practice in l ....Evidence based clinical practice guidelines have the potential to improve clinical practice through providing health care workers with the most reliable information on which to base their treatment decisions. Many governments and organisations are investing significantly in the development of guidelines for common and important clinical disorders. To date, however, we do not fully understand how to increase the uptake of guidelines and facilitate health care workers to change their practice in line with the guideline's recommendations. This project aims to work with general practitioners to develop a method or strategy to increase the uptake of guidelines for the treatment of acute low back pain, particularly to reduce the number of patients who are unnecessarily x-rayed, and to increase advice to stay active. The effectiveness of the developed strategy will be tested by randomly assigning general practice clinics to either receive the intervention or to have access to the guidelines without any extra interventions (such as training and reminders) to help doctors change their practice. Both the doctor's practice, and patient outcomes of pain and disability will be measured to determine not only if the doctors followed the guidelines, but whether this resulted in an improvement in patient outcome. The findings of this study will help us understand the best ways to improve adhesion to guidelines and so has the potential to be applied to other conditions presenting to general practice where there are recommendations not currently being implemented into practice.Read moreRead less
The Effect Of Glucosamine Sulphate On Structural Disease Progression In Knee Osteoarthritis
Funder
National Health and Medical Research Council
Funding Amount
$1,250,214.00
Summary
Osteoarthritis (OA) is a joint disease characterized by a progressive loss of cartilage and joint space resulting in increasing pain and difficulty performing usual daily activities. OA is the leading health problem amongst older Australians and a National Health Priority area. There is no known cure for OA and no intervention demonstrated to slow disease progression or delay time to joint replacement surgery. Currently patients are managed symptomatically with all clinical guidelines recommendi ....Osteoarthritis (OA) is a joint disease characterized by a progressive loss of cartilage and joint space resulting in increasing pain and difficulty performing usual daily activities. OA is the leading health problem amongst older Australians and a National Health Priority area. There is no known cure for OA and no intervention demonstrated to slow disease progression or delay time to joint replacement surgery. Currently patients are managed symptomatically with all clinical guidelines recommending paracetamol as 'the preferred long term oral analgesic'. This recommendation is based on the increased risk of serious gastrointestinal, cardiovascular and renal diseases with long-term NSAIDs use in older people. However, NSAIDs appear to provide better pain relief for patients with more than mild joint pain. Amongst patients with OA, there is much demand for the dietary supplement glucosamine sulphate. Product marketing has led to the belief that glucosamine is able to slow the rate of joint destruction and cartilage loss and help ease joint pain with, in contrast to NSAIDs, little risk of side effects. However, the few trials conducted to date have been inconclusive. If the marketing claims are unjustified, many older people are wasting limited financial resources and due to unrealistic expectations of the benefit of glucosamine, placing a lower priority on lifestyle changes of proven effectiveness, such as regular exercise and weight loss. A total of 900 patients with knee OA will be randomly allocated to glucosamine sulphate or matching placebo capsules for two years. The main outcomes will be the rate of joint space narrowing, use of NSAIDs and physical disability. If glucosamine results in slowing disease progression or in reducing NSAIDs consumption, the widespread use of this product would effectively decrease pain, disability and NSAIDs-related illnesses amongst the increasing number of people with OA.Read moreRead less