Conceptualising health literacy from the patient perspective.

Objective: A person's health literacy, i.e., their ability to seek, understand and use health information, is a critical determinant of whether they are able to actively participate in their healthcare.

A systematic grounded approach to the development of complex interventions: the Australian WorkHealth Program--arthritis as a case study.

Despite demands for evidence-based research and practice, little attention has been given to systematic approaches to the development of complex interventions to tackle workplace health problems. This paper outlines an approach to the initial stages of a workplace program development which integrates health promotion and disease management. The approach commences with systematic and genuine processes of obtaining information from key stakeholders with broad experience of these interventions.

A network meta-analysis of randomized controlled trials of biologics for rheumatoid arthritis: a Cochrane overview.

Background: We sought to compare the benefits and safety of 6 biologics (abatacept, adalimumab, anakinra, etanercept, infliximab and rituximab) in patients with rheumatoid arthritis.

Methods: In this network meta-analysis, we included all completed and updated Cochrane reviews on biologics for rheumatoid arthritis. We included data from all placebo-controlled trials that used standard dosing regimens.

Vertebroplasty appears no better than placebo for painful osteoporotic spinal fractures, and has potential to cause harm.

Two randomised placebo-controlled trials show the importance of establishing the efficacy of procedures before adopting them into clinical practice.

Biologics for rheumatoid arthritis: an overview of Cochrane reviews.

Background: The biologic disease-modifying anti-rheumatic drugs (DMARDs) are very effective in treating rheumatoid arthritis (RA), however there is a lack of head-to-head comparison studies.

Objectives: To compare the efficacy and safety of abatacept, adalimumab, anakinra, etanercept, infliximab, and rituximab in patients with RA.

Methods: This 'Overview of Reviews' was done by including all Cochrane Reviews on Biologics for RA available in The Cochrane Library.

Quantifying the impact of transient joint symptoms, chronic joint symptoms, and arthritis: a population-based approach.

Objective: To estimate the prevalence and co-occurrence of self-reported doctor-diagnosed arthritis, chronic joint symptoms (pain, aching, stiffness, or swelling on most days for a month), and transient joint symptoms (pain, aching, stiffness, or swelling but not on most days for a month), and to compare the sociodemographic characteristics, activity limitations, and health-related quality of life (HRQOL) of people with joint conditions with those who have no self-reported doctor-diagnosed arthritis and no joint symptoms.

Methods: Data from the 2004 population-based South Australian Health Omnibus Survey (n = 2,840, ages 18-96 years) were used in the study. Activity limitations were assessed using 10 activity limitations questions from the Short Form 36 health survey.

Shoulder-specific disability measures showed acceptable construct validity and responsiveness.

Objective: To compare the construct validity and responsiveness of the Shoulder Pain and Disability Index (SPADI), Croft Index, and disabilities of the arm, shoulder, and hand (DASH) for patients with adhesive capsulitis and to compare these with pain on a visual analog scale, the Health Assessment Questionnaire, and the problem-elicitation technique.

Study Design And Setting: Two randomized double-blind placebo-controlled trials of interventions for adhesive capsulitis were performed. Both trials recruited patients from community-based physiotherapy practices.

A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures.

Background: Vertebroplasty has become a common treatment for painful osteoporotic vertebral fractures, but there is limited evidence to support its use.

Methods: We performed a multicenter, randomized, double-blind, placebo-controlled trial in which participants with one or two painful osteoporotic vertebral fractures that were of less than 12 months' duration and unhealed, as confirmed by magnetic resonance imaging, were randomly assigned to undergo vertebroplasty or a sham procedure. Participants were stratified according to treatment center, sex, and duration of symptoms (< 6 weeks or > or = 6 weeks).

Topical glyceryl trinitrate for rotator cuff disease.

Background: Rotator cuff disease is a common cause of shoulder pain. Topical glyceryl trinitrate is a possible new treatment.

Objectives: To determine the effectiveness and safety of topical glyceryl trinitrate for rotator cuff disease.

Efficacy of subacromial ropivacaine infusion for rotator cuff surgery. A randomized trial.

Background: Local anesthetic administered directly to the operative site by slow infusion has become a popular supplementary pain management strategy following rotator cuff surgery, but it is expensive and there is little conclusive evidence that it provides additional benefits. The purpose of this study was to determine the effectiveness and safety of ropivacaine infusion following arthroscopic or mini-incision rotator cuff surgery.

Methods: We performed a randomized, participant and outcome assessor-blinded, placebo-controlled trial.

Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey.

The objective of this paper is to measure health literacy in a representative sample of the Australian general population using three health literacy tools; to consider the congruency of results; and to determine whether these assessments were associated with socio-demographic characteristics. Face-to-face interviews were conducted in a stratified random sample of the adult Victorian population identified from the 2004 Australian Government Electoral Roll. Participants were invited to participate by mail and follow-up telephone call.

Back pain: a National Health Priority Area in Australia?

The aim of the National Health Priority Area (NHPA) initiative is to promote cooperation between government and non-government organisations to monitor, report on and develop strategies to improve health outcomes for Australians. The seven existing NHPAs (cancer control, injury prevention and control, cardiovascular health, mental health, diabetes mellitus, asthma and musculoskeletal conditions) were selected on the basis of their profound burden on the health of Australians. Up to eighty per cent of Australians will experience back pain at some point in their lives and 10% will experience significant disability as a result.

Doctors with a special interest in back pain have poorer knowledge about how to treat back pain.

Study Design: We conducted an observational study using mailed questionnaires to 3 random samples of general practitioners from Victoria and New South Wales, Australia in 1997, 2000, and 2004.

Objective: To determine whether general practitioners' beliefs about low back pain (LBP) differ according to whether they have a special interest in back pain, musculoskeletal, or occupational medicine; and whether these beliefs are modified by having had continuing medical education (CME) about back pain in the previous 2 years.

Summary Of Background Data: Physician surveys continue to demonstrate that general practitioners only partially manage LBP in an evidence-based way.

Patient assessment of medication information leaflets and validation of the Evaluative Linguistic Framework (ELF).

Objective: To obtain patient feedback about the structure and quality of medication information leaflets and validate the usefulness of the Evaluative Linguistic Framework (ELF) for improving written communication with patients.

Methods: Triangulated feedback about a set of rheumatoid arthritis (RA) medication leaflets, some developed with knowledge of the ELF, was obtained from 27 people with RA from interviews, focus group discussion and self-administered questionnaires. The principal elements of the framework were investigated: overall generic structure and functions of each stage, interpersonal relationship between writer and reader, technicality of language and density of information.

Stakeholder Satisfaction with the Australian Rheumatology Association Database (ARAD).

Background: The Australian Rheumatology Association Database (ARAD) is a voluntary national registry for monitoring the long-term benefits and safety of biological disease-modifying anti-rheumatic drugs (bDMARDs) for inflammatory arthritis. Both rheumatologists and patients contribute data to the ARAD.

Objective: To evaluate the satisfaction of patients and rheumatologists with the ARAD.

Self-management education en masse: effectiveness of the Back Pain: Don't Take It Lying Down mass media campaign.

Despite the availability of a range of Australian self-management support programs targeting the individual patient and/or health professional, three-quarters of Australians have at least one long-term medical condition, suggesting that a more comprehensive public health approach is needed. Use of mass media to deliver community health messages is a well established public health strategy. It may enhance more targeted approaches with its ability to reach large numbers of people simultaneously, including those difficult to identify, high-risk groups and those difficult to reach through traditional medical delivery.

Medication information leaflets for patients: the further validation of an analytic linguistic framework.

While clinicians may routinely use patient information leaflets about drug therapy, a poorly conceived leaflet has the potential to do harm. We previously developed a novel approach to analysing leaflets about a rheumatoid arthritis drug, using an analytic approach based on systemic functional linguistics. The aim of the present study was to verify the validity of the linguistic framework by applying it to two further arthritis drug leaflets.

Efficacy and safety of vertebroplasty for treatment of painful osteoporotic vertebral fractures: a randomised controlled trial [ACTRN012605000079640].

Background: Vertebroplasty is a promising but as yet unproven treatment for painful osteoporotic vertebral fractures. It involves radiographic-guided injection of various types of bone cement directly into the vertebral fracture site. Uncontrolled studies and two controlled quasi-experimental before-after studies comparing volunteers who were offered treatment to those who refused it, have suggested an early benefit including rapid pain relief and improved function.

Is health equity considered in systematic reviews of the Cochrane Musculoskeletal Group?

Objective: To determine whether Cochrane Musculoskeletal Group (CMSG) systematic reviews and corresponding primary studies of rheumatoid arthritis interventions report and analyze the data needed to assess the effectiveness of interventions in reducing socioeconomic differences in health and/or improving the health of the poor.

Methods: We selected all CMSG reviews on rheumatoid arthritis published since issue 1, 2003. Fourteen reviews were identified; 147 of the 156 primary studies included in these reviews were obtained and assessed.

Searching for a conceptual framework for nonspecific low back pain.

Diverse views exist regarding the underlying nature of nonspecific low back pain (NSLBP). This study aimed to (i) develop a conceptual framework of NSLBP based on the expressed beliefs of those who treat and/or research NSLBP and (ii) determine whether these beliefs are discretely clustered and whether they are associated with participant characteristics. Surveys were completed by participants (n=162) of the 2006 Amsterdam International Low Back Pain Forum and a low back pain meeting (n=488) in Melbourne.

A randomized controlled trial of extracorporeal shock wave therapy for lateral epicondylitis (tennis elbow).

Objective: The aims of this double-blind, randomized, placebo-controlled trial were to determine whether ultrasound-guided extracorporeal shock wave therapy (ESWT) reduced pain and improved function in patients with lateral epicondylitis (tennis elbow) in the short term and intermediate term.

Methods: Sixty-eight patients from community-based referring doctors were randomized to receive 3 ESWT treatments or 3 treatments at a subtherapeutic dose given at weekly intervals. Seven outcome measures relating to pain and function were collected at followup evaluations at 6 weeks, 3 months, and 6 months after completion of the treatment.