Bout of the corner men and not the boxers? Contextual effects flex their muscles

Englund, Martin

doi:10.1136/annrheumdis-2017-211664

Cited by 17 publications

(19 citation statements)

References 14 publications

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“…The exercise program seemed to have a small, clinically significant effect on pain after 14 weeks although the within group improvement failed to reach clinical significance in nearly all other parameters. The symptomatic improvement could be ascribed to placebo effects, regression to the mean 26 or other factors associated with pain perception, such as pain sensitivity 21 . The pain causing mechanisms in OA are poorly understood and it has been hypothesized that pain sensitization, i.e., altered nociceptive processing within the peripheral and central nervous system, might play a central role 27 .…”

Section: Discussionmentioning

confidence: 99%

The effect of intra-articular glucocorticosteroids and exercise on symptoms and bone marrow lesions in knee osteoarthritis: a secondary analysis of results from a randomized controlled trial

Nielsen

Boesen

Jurik

et al. 2018

Osteoarthritis and Cartilage

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Section: Discussionmentioning

confidence: 99%

The effect of intra-articular glucocorticosteroids and exercise on symptoms and bone marrow lesions in knee osteoarthritis: a secondary analysis of results from a randomized controlled trial

Nielsen

Boesen

Jurik

et al. 2018

Osteoarthritis and Cartilage

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“…Contextual effects would not work in the previous two studies because they showed no improvements of clinical outcomes in the TAU group [8,9]. On the other hand, contextual effects in chronic pain conditions predominantly include the placebo response and the regression to the mean phenomenon [28]. In this regard, participants in the TAU group showed significant improvements (time-course effects) in pain disability, indicating contextual effects in the current study.…”

Section: Discussionmentioning

confidence: 54%

Open-Label Placebo Trial among Japanese Patients with Chronic Low Back Pain

Ikemoto

Ueno

Arai

et al. 2020

Pain Research and Management

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Background. The aim of this study was to confirm the effectiveness of open-label placebo (OLP) in Japanese patients with chronic low back pain (CLBP), similar to previous reports, and to investigate its short- and medium-term effects in this study population. Methods. Fifty-two patients with CLBP were randomized into a treatment as usual (TAU) group (n = 26) or an OLP + TAU group (n = 26) for 12 weeks. The TAU included advice to remain active and exercise in conjunction with recent psychological education based on a self-management strategy. In contrast, participants in the OLP + TAU group were instructed to take two OLP capsules a day. Outcome measures were assessed at baseline and at weeks 3 and 12 using the Roland–Morris Disability Questionnaire (RMDQ), Numerical Rating Scale (NRS) for pain intensity, and the Timed-Up-and-Go (TUG) test. Difference in outcomes between the two groups was compared at the two follow-up points. Results. Although all participants completed the 3-week follow-up, four patients (two in each group) were lost to follow-up beyond week 3. There were no significant intergroup differences in changes in the RMDQ score ( p = 0.40 ), pain-NRS score ( p = 0.19 ), and TUG time ( p = 0.98 ) at week 3. Two-way repeated measure analyses of covariance showed significant time-course effects but did not show group effects or any interactions between the time-course and group in terms of the RMDQ score. However, it did not show any effects in the pain-NRS score and TUG time at week 12. Conclusions. The OLP + TAU group showed no superior findings in comparison with the TAU group after 3 weeks and 12 weeks for Japanese patients with CLBP. Nonetheless, significant improvements in functional disability were observed in both groups.

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“…Over the past decade, evidence has accumulated that questions both the rationale for, and the effectiveness of APM for degenerative meniscus lesions 6 7. Additionally, concerns have been expressed on the harms associated with the procedure7–9 and the potential detrimental effect of the procedure on the progression of osteoarthritis 10–12. Still, the number of surgical procedures performed in the treatment of degenerative meniscus lesions remains high 13–17…”

Section: Introductionmentioning

confidence: 99%

“…Orthopaedic surgeons have expressed concerns about the generalisability of the trial results and point out that the study samples are not representative of the subjects they select for surgery in their day-to-day clinical practice 18–24. The common perception by most surgeons is that there are subgroups of patients that do need the procedure to improve 8. Hence, applying the mean effects of randomised controlled trials (RCTs) to individual patients in day-to-day practice runs against the intuitive approach of doctors to use the specific characteristics of a particular patient to tailor management accordingly.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic meniscectomy versus non-surgical or sham treatment in patients with MRI confirmed degenerative meniscus lesions: a protocol for an individual participant data meta-analysis

Wijn¹,

Rovers²,

Rongen³

et al. 2020

BMJ Open

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IntroductionArthroscopic partial meniscectomy (APM) after degenerative meniscus tears is one of the most frequently performed surgeries in orthopaedics. Although several randomised controlled trials (RCTs) have been published that showed no clear benefit compared with sham treatment or non-surgical treatment, the incidence of APM remains high. The common perception by most orthopaedic surgeons is that there are subgroups of patients thatdoneed APM to improve, and they argue that each study sample of the existing trials is not representative for the day-to-day patients in the clinic. Therefore, the objective of this individual participant data meta-analysis (IPDMA) is to assess whether there are subgroups of patients with degenerative meniscus lesions who benefit from APM in comparison with non-surgical or sham treatment.Methods and analysisAn existing systematic review will be updated to identify all RCTs worldwide that evaluated APM compared with sham treatment or non-surgical treatment in patients with knee symptoms and degenerative meniscus tears. Time and effort will be spent in contacting principal investigators of the original trials and encourage them to collaborate in this project by sharing their trial data. All individual participant data will be validated for missing data, internal data consistency, randomisation integrity and censoring patterns. After validation, all datasets will be combined and analysed using a one-staged and two-staged approach. The RCTs’ characteristics will be used for the assessment of clinical homogeneity and generalisability of the findings. The most important outcome will be the difference between APM and control groups in knee pain, function and quality of life 2 years after the intervention. Other outcomes of interest will include the difference in adverse events and mental health.Ethics and disseminationAll trial data will be anonymised before it is shared with the authors. The data will be encrypted and stored on a secure server located in the Netherlands. No major ethical concerns remain. This IPDMA will provide the evidence base to update and tailor diagnostic and treatment protocols as well as (international) guidelines for patients for whom orthopaedic surgeons consider APM. The results will be submitted for publication in a peer-reviewed journal.PROSPERO registration numberCRD42017067240.

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Bout of the corner men and not the boxers? Contextual effects flex their muscles

Cited by 17 publications

References 14 publications

The effect of intra-articular glucocorticosteroids and exercise on symptoms and bone marrow lesions in knee osteoarthritis: a secondary analysis of results from a randomized controlled trial

The effect of intra-articular glucocorticosteroids and exercise on symptoms and bone marrow lesions in knee osteoarthritis: a secondary analysis of results from a randomized controlled trial

Open-Label Placebo Trial among Japanese Patients with Chronic Low Back Pain

Arthroscopic meniscectomy versus non-surgical or sham treatment in patients with MRI confirmed degenerative meniscus lesions: a protocol for an individual participant data meta-analysis

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