"It's hard to say anything definitive about what severity really is": lay conceptualisations of severity in a healthcare context.

Background: Demand for healthcare outweighs available resources, making priority setting a critical issue. 'Severity' is a priority-setting criterion in many healthcare systems, including in Norway, Sweden, the Netherlands, and the United Kingdom. However, there is a lack of consensus on what severity means in a healthcare context, both in the academic literature and in policy.

Charting public views on the meaning of illness severity.

Background: Illness severity is a central principle in multiple priority-setting frameworks, yet there is a paucity of research on public views regarding the meaning of illness severity. This study builds on the findings of a Q methodology study with members of the public that identified four general viewpoints on the meaning of illness severity. Here, we investigate the support for those viewpoints among the Norwegian population.

A severely fragmented concept: Uncovering citizens' subjective accounts of severity of illness.

Universal healthcare is constrained by national governments' finite health resources. This gives rise to complex priority-setting dilemmas. In several universal healthcare systems, the notion of severity (Norwegian: 'alvorlighet') is a key consideration in priority setting, such that treatments for 'severe' illness may be prioritised even when evidence suggests it would not be as cost-effective as treatment options for other conditions.

Breaking the cycle of recurrent fracture: implementing the first fracture liaison service (FLS) in British Columbia, Canada.

Unlabelled: Fractures occurring with very little trauma are often caused by osteoporosis and can lead to disability. This study demonstrates that a coordinator working with an orthopaedic team can significantly increase the number of individuals receiving appropriate treatments during their after-fracture care to prevent future fractures from occurring.

Purpose: Well-implemented Fracture Liaison Service (FLS) programs increase appropriate investigation and treatment for osteoporosis after low trauma fracture.

Delivery of Peer Support Through a Self-Management mHealth Intervention (Healing Circles) in Patients With Cardiovascular Disease: Protocol for a Randomized Controlled Trial.

Background: Cardiovascular disease (CVD) is a leading cause of hospitalization and death around the world. The prevalence of CVD is increasing and, therefore, development and investigation of effective programs to help people better self-manage their CVD and prevent secondary complications are needed.

Objective: In this paper, we report on a protocol to evaluate Healing Circles-an evidence-based and patient-informed peer support mobile health program designed to facilitate self-management and support patients in their recovery from and management of CVD.

Health Conditions: Effect on Function, Health-Related Quality of Life, and Life Satisfaction After Traumatic Spinal Cord Injury. A Prospective Observational Registry Cohort Study.

Objective: To analyze relations among injury, demographic, and environmental factors on function, health-related quality of life (HRQoL), and life satisfaction in individuals with traumatic spinal cord injury (SCI).

Design: Prospective observational registry cohort study.

Setting: Specialized acute and rehabilitation SCI centers.

The Use of Text Messaging to Improve the Hospital-to-Community Transition in Acute Coronary Syndrome Patients (Txt2Prevent): Intervention Development and Pilot Randomized Controlled Trial Protocol.

Background: Acute coronary syndrome, including acute myocardial infarction (AMI), is one of the leading causes for hospitalization, with AMI 30-day readmission rates around 20%. Supporting patient information needs and increasing adherence to recommended self-management behaviors during transition from hospital to home has the potential to improve patient outcomes. Text messages have been effective in other interventions and may be suitable to provide support to patients during this transition period.

"When I saw walking I just kind of took it as wheeling": interpretations of mobility-related items in generic, preference-based health state instruments in the context of spinal cord injury.

Background: In health economic analyses, health states are typically valued using instruments with few items per dimension. Due to the generic (and often reductionist) nature of such instruments, certain groups of respondents may experience challenges in describing their health state. This study is concerned with generic, preference-based health state instruments that provide information for decisions about the allocation of resources in health care.

Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review.

Background: Low back pain (LBP) is a major health problem, having a substantial effect on peoples' quality of life and placing a significant economic burden on healthcare systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear.

Objectives: To identify, document and appraise studies reporting on the cost effectiveness of non-invasive and non-pharmacological treatment options for LBP.

Attitude to health risk in the Canadian population: a cross-sectional survey.

Background: Risk is a ubiquitous part of health care. Understanding how people respond to risks is important for predicting how populations make health decisions. Our objective was to seek preliminary descriptive insights into the attitude to health risk in the Canadian population and factors associated with heterogeneity in risk attitude.

Exclusion Criteria in National Health State Valuation Studies: A Systematic Review.

Background: Health state valuation data are often excluded from studies that aim to provide a nationally representative set of values for preference-based health-related quality of life (HRQoL) instruments. The purpose was to provide a systematic examination of exclusion criteria used in the derivation of societal scoring algorithms for preference-based HRQoL instruments.

Methods: Data sources included MEDLINE, official instrument websites, and publication reference lists.

Examining the relationship between health-related quality of life and increasing numbers of diagnoses.

Purpose: Little is known about estimating utilities for comorbid (or 'joint') health states. Several joint health state prediction models have been suggested (for example, additive, multiplicative, best-of-pair, worst-of-pair, etc.), but no general consensus has been reached.

Implementing stratified primary care management for low back pain: cost-utility analysis alongside a prospective, population-based, sequential comparison study.

Study Design: Within-study cost-utility analysis.

Objective: To explore the cost-utility of implementing stratified care for low back pain (LBP) in general practice, compared with usual care, within risk-defined patient subgroups (that is, patients at low, medium, and high risk of persistent disabling pain).

Summary Of Background Data: Individual-level data collected alongside a prospective, sequential comparison of separate patient cohorts with 6-month follow-up.

Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials.

Objectives: Evidence regarding the cost-effectiveness of joint protection and hand exercises for the management of hand OA is not well established. The primary aim of this study is to assess the cost-effectiveness (cost-utility) of these management options. In addition, given the absence of consensus regarding the conduct of economic evaluation alongside factorial trials, we compare different analytical methodologies.

Comparison of contemporaneous EQ-5D and SF-6D responses using scoring algorithms derived from similar valuation exercises.

Objectives: Poor agreement between preference-based health-related quality-of-life instruments has been widely reported across patient and community-based samples. This study compares index scores generated from contemporaneous EQ-5D (3-level version) and SF-6D (SF-36 version) responses using scoring algorithms derived from independently-conducted Australian population-representative discrete choice experiments (DCEs), providing the first comparative analysis of health state valuations using the same method of valuation across the full value sets.

Methods: EQ-5D and SF-6D responses from seven patient data sets were transformed into health state valuations using published DCE-derived scoring algorithms.

A multicentre, pragmatic, parallel group, randomised controlled trial to compare the clinical and cost-effectiveness of three physiotherapy-led exercise interventions for knee osteoarthritis in older adults: the BEEP trial protocol (ISRCTN: 93634563).

Background: Exercise is consistently recommended for older adults with knee pain related to osteoarthritis. However, the effects from exercise are typically small and short-term, likely linked to insufficient individualisation of the exercise programme and limited attention to supporting exercise adherence over time. The BEEP randomised trial aims to improve patients' short and long-term outcomes from exercise.

Pain location matters: the impact of leg pain on health care use, work disability and quality of life in patients with low back pain.

Purpose: In low back pain (LBP) patients, those with radiating leg pain or sciatica have poorer pain and disability outcomes. Few studies have assessed the effect of leg pain on health care use and quality of life.

Methods: Prospective cohort study of 1,581 UK LBP primary care consulters.

Perceptions of individuals living with spinal cord injury toward preference-based quality of life instruments: a qualitative exploration.

Background: Generic preference-based health-related quality of life instruments are widely used to measure health benefit within economic evaluation. The availability of multiple instruments raises questions about their relative merits and recent studies have highlighted the paucity of evidence regarding measurement properties in the context of spinal cord injury (SCI). This qualitative study explores the views of individuals living with SCI towards six established instruments with the objective of identifying 'preferred' outcome measures (from the perspective of the study participants).

Exploring psychometric properties of the SF-6D, a preference-based health-related quality of life measure, in the context of spinal cord injury.

Purpose: The validity of the SF-6D, a preference-based measure of health-related quality of life, is not well explored in the context of spinal cord injury (SCI). The aim of this analysis was to assess appropriate measurement properties of the SF-6D in a sample of individuals living with SCI.

Methods: Longitudinal data from the Rick Hansen Spinal Cord Injury Registry were used.

Effect of stratified care for low back pain in family practice (IMPaCT Back): a prospective population-based sequential comparison.

Purpose: We aimed to determine the effects of implementing risk-stratified care for low back pain in family practice on physician's clinical behavior, patient outcomes, and costs.

Methods: The IMPaCT Back Study (IMplementation to improve Patient Care through Targeted treatment) prospectively compared separate patient cohorts in a preintervention phase (6 months of usual care) and a postintervention phase (12 months of stratified care) in family practice, involving 64 family physicians and linked physical therapy services. A total of 1,647 adults with low back pain were invited to participate.

Short Form health surveys and related variants in spinal cord injury research: a systematic review.

Context: 'Short Form' health surveys - such as the SF-36 and SF-12 - are widely used in medical research. Spinal cord injury (SCI) is no exception, despite oft-cited concerns regarding measurement properties for populations with physical impairment.

Objective: To provide a comprehensive overview of the use of Short Form health surveys and their variants within the SCI literature.

Trial-based clinical and economic analyses: the unhelpful quest for conformity.

Where there is conformity across the findings, interpretation and implications of 'clinical' and 'economic' research, there is limited cause for concern. However, there is often unease when apparent contradictory conclusions are drawn from the same study. Given the ever increasing role for economic evaluation in healthcare decision making, this commentary challenges the necessity of compatibility between clinical and economic evaluation.

Inconsistencies in NICE guidance for acupuncture: reanalysis and discussion.

Background: Acupuncture received a positive recommendation in the National Institute for Health and Clinical Excellence (NICE) clinical guideline for low back pain (LBP). However, no such recommendation was forthcoming in the NICE clinical guideline for osteoarthritis (OA). Importantly, the two guidelines adopted different treatment comparators in their economic analyses of acupuncture; in the LBP guideline 'usual care' was used (with no consideration of placebo/sham interventions), whereas 'sham acupuncture' was the comparator in the OA guideline.