ObjectivesThe aim of this Delphi survey was to establish an international consensus on the most useful outcome measures for research on the effectiveness of non-pharmacological interventions for migraine. This is important, since guidelines for pharmacological trials recommend measuring the frequency of headaches with 50% reduction considered a clinically meaningful effect. It is unclear whether the same recommendations apply to complementary (or adjunct) non-pharmacological approaches, whether the same cut-off levels need to be considered for effectiveness when used as an adjunct or stand-alone intervention, and what is meaningful to patients.SettingUniversity-initiated international survey.ParticipantsThe expert panel was chosen based on publications on non-pharmacological interventions in migraine populations and from personal contacts. 35 eligible researchers were contacted, 12 agreed to participate and 10 completed all 3 rounds of the survey. To further explore how migraine patients viewed potential outcome measures, four migraine patients were interviewed and presented with the same measurement tools as the researchers.ProceduresThe initial Delphi round was based on a systematic search of the literature for outcome measures used in non-pharmacological interventions for headache. Suggested outcome measures were rated by each expert, blinded towards the other members of the panel, for its usefulness on a 5-point Likert scale ranging from definitely not useful to extremely useful. Results were combined using median values and IQRs. Tools rated overall as definitely or probably not useful were excluded from subsequent rounds. Experts further suggested additional outcome measures that were presented to the panel in subsequent rounds. Additionally, experts were asked to rank the most useful tools and provide information on feasible cut-off levels for effectiveness for the three highest ranked tools.ResultsResults suggest the use of the Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6) and headache frequency as primary outcome measures. Patient experts suggested the inclusion of a measure of quality of life and evaluation of associated symptoms and fear of attacks.ConclusionsRecommendations are for the use of the MIDAS, the HIT-6 and headache frequency, in combination with an outcome measure for quality of life. Associated symptoms and fear of attacks should also be considered as secondary outcomes, if relevant for the individual target population. The cut-off level for effectiveness should be lower for non-pharmacological interventions, especially when used as an adjunct to medication.Trial registration numberGerman Register of Clinical Trials (DRKS00011777)
Zhang J., Madsen B. and Jensen-Butler C. (2007) Regional economic impacts of tourism: the case of Denmark, Regional Studies 41, 839-853. The Danish interregional general equilibrium model LINE is presented together with its tourism submodel. The model is used to analyse the importance of tourism in regional economies and to decompose regional tourism multipliers. The difference between direct and derived effects is examined; and by using the model, the factors that determine the size of the direct effects and derived effects are identified. The analysis is applied to Danish regions which are divided into urban and rural regions. In general, the results show that tourism multipliers are larger in urban than in rural areas. Factors such as interregional trade, commuting and shopping leakage have to be taken into consideration when evaluating the derived effects. When the leakage is large, the tourism multiplier tends to be small. The paper also draws attention to the difference between absolute and relative impacts of tourism on the regional economy. Zhang J., Madsen B. et Jensen-Butler C. (2007) Les retombees regionales du tourisme: etude de cas du Danemark, Regional Studies 41, 839-853. On presente le modele interregional danois d'equilibre general appele LINE conjointement avec le modele secondaire sur le tourisme. On se sert du modele afin d'analyser l'importance du tourisme dans les economies regionales et pour decomposer les multiplicateurs regionaux du tourisme. On examine la difference entre les retombees directes et indirectes et, a partir du modele, on identifie les facteurs qui determinent l'importance des retombees directes et indirectes. On applique l'analyse aux regions danoises, divisees en zones urbaines et rurales. En regle generale, les resultats laissent voir que les multiplicateurs du tourisme s'averent plus importants dans les zones urbaines qu'ils ne le sont dans les zones rurales. Pour evaluer les retombees indirectes, il faut tenir compte d'autres facteurs, tels les echanges interregionaux, les migrations quotidiennes et la fuite des depenses des menages. Quand la fuite s'avere importante, le multiplicateur du tourisme a tendance a etre negligeable. L'article cherche aussi a attirer l'attention sur la difference entre les retombees absolues et relatives du tourisme sur l'economie regionale. Retombees economiques du tourisme Multiplicateurs du tourisme Modelisation macroeconomique interregionale Regions danoises Zhang J., Madsen B. und Jensen-Butler C. (2007) Die regionalen wirtschaftlichen Auswirkungen des Fremdenverkehrs: der Fall Danemark, Regional Studies 41, 839-853. Vorgestellt wird das danische interregionale allgemeine Gleichgewichtsmodell LINE sowie dessen Fremdenverkehrs-Untermodell. Anhand dieses Modells wird die Bedeutung des Fremdenverkehrs fur regionale Wirtschaften analysiert, und es werden die Multiplikatoren fur den regionalen Fremdenverkehr aufgeschlusselt. Der Unterschied zwischen direkten und abgeleiteten Auswirkungen wird untersucht, und es werden mit Hilfe des Modells di...
Background Strength training has shown effects in reducing neck pain. As neck pain is highly prevalent in tension-type headache (TTH), it is relevant to examine the effect of strength training of the shoulder muscles on TTH patients. Aim To examine the effect of strength training of the shoulder/neck muscles on TTH frequency and duration. Methods Sixty patients with TTH were randomised into strength training or a control group. The strength training group trained ten weeks with elastic resistance bands. The control group performed ergonomic and posture correction. Efficacy was evaluated at follow-up after 19-22 weeks. Results Twenty-three patients completed strength training and 21 completed ergonomic and posture correction (per-protocol). No between-group effect was detected, but within groups numerical reductions were noted in both groups from baseline to follow-up. Frequency of TTH in the strength training group decreased by 11% ( P = 0.041) and duration decreased by10% ( P = 0.036), while the ergonomic and posture correction group showed a significant reduction in frequency of 24% ( P = 0.0033) and a decrease in duration of 27% ( P = 0.041). Conclusion No significant difference between the groups was found and the within-group effects did not reach clinical significance. Combining all the elements into a multifaceted intervention could prove more useful and should be further explored in future studies. Clinical trials registration number NCT02984826.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.