Objectives To understand the impact of the COVID-19 pandemic on access to healthcare services for... more Objectives To understand the impact of the COVID-19 pandemic on access to healthcare services for patients with inflammatory and non-inflammatory MSK conditions. Methods Three established cohorts which included individuals with axial spondyloarthritis, psoriatic arthritis, and musculoskeletal pain completed a questionnaire between July and December 2020. In parallel, a subset of individuals participated in semi-structured interviews. Results 1054 people (45% female, median age 59 years) were included in the quantitative analyses. Qualitative data included 447 free-text questionnaire responses and 23 interviews. 57% respondents had tried to access care since the start of UK national lockdown. Over a quarter reported being unable to book any type of healthcare appointment. GP appointments were less likely to be delayed or cancelled compared with hospital appointments. Younger age, unemployment/health-related retirement, DMARD therapy, anxiety or depression and being extremely clinical...
Objectives: To determine the prevalence of facial pain and to examine the hypothesis that symptom... more Objectives: To determine the prevalence of facial pain and to examine the hypothesis that symptoms are associated with socio-demographic, dental, adverse psychological factors and pain elsewhere in the body. Material and Methods: Cross-sectional population data were obtained from UK Biobank (www.ukbiobank.ac.uk/) study which was conducted in 2006- 2010 and recruited over 500,000 people. Results: The overall prevalence of facial pain (FP) was 1.9 % (women 2.4%, men 1.2%) of which 48 % was chronic. The highest prevalence was found in the 51- 55 age group (2.2%) and the lowest in the 66- 73 age group (1.4%). There was a difference in prevalence by ethnicity (0.8 % and 2.7 % in persons reporting themselves as Chinese and Mixed respectively). Prevalence of FP significantly associated with all measures of social class with the most deprived and on lowest income showing the highest prevalence (2.5 % and 2.4 % respectively). FP was more common in individuals who rated themselves as extremel...
ObjectiveCognitive–behavioural therapy (CBT) has been shown to be effective in the management of ... more ObjectiveCognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk.MethodsA population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT (tCBT). The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EuroQol Questionnaire-five dimensions-five levels/EQ-5D-5L) used as part of a health economic assessment.Results996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were women. At 12 months there was no difference in the onset of CWP (tCBT: 18.0% vs UC: 17.5%; OR ...
Objectives The aim was to develop and validate a simple clinical prediction model, based on easil... more Objectives The aim was to develop and validate a simple clinical prediction model, based on easily collected preoperative information, to identify patients at high risk of pain and functional disability 6 months after total knee arthroplasty (TKA). Methods This was a multicentre cohort study of patients from nine centres across the UK, who were undergoing a primary TKA for OA. Information on sociodemographic, psychosocial, clinical and quality-of-life measures were collected at recruitment. The primary outcome measure for this analysis was the Oxford knee score (OKS), measured 6 months postoperatively by postal questionnaire. Multivariable logistic regression was used to develop the model. Model performance (discrimination and calibration) and internal validity were assessed, and a simple clinical risk score was developed. Results Seven hundred and twenty-one participants (mean age 68.3 years; 53% female) provided data for the present analysis, and 14% had a poor outcome at 6 months...
The current study investigated whether associations between pain and the additional symptoms asso... more The current study investigated whether associations between pain and the additional symptoms associated with fibromyalgia are different in persons with chronic widespread (CWP) compared to multi-site pain (MSP), with or without joint areas. Six studies were utilized: 1958 British birth cohort, EpiFunD, Kid LBP, MUSICIAN, SHAMA and WHEST (females) studies. MSP was defined as the presence of pain in ≥8/≥10 body sites (adults/children) indicated on 4-view body manikins; conducted firstly to include joints (+joints) and secondly without (-joints). The relationship between pain and fatigue, sleep disturbance, somatic symptoms and mood impairment, were assessed using logistic regression. Results are presented as odds ratios (OR), with 95% confidence intervals (CI). There were 34,818 participants across the study populations (adults: mean age range 42-56yrs, % male 43-51 (excluding WHEST), CWP prevalence 12-17%). Amongst those reporting MSP, the proportion reporting CWP ranged between 62-7...
Cognitive behavioural therapy (CBT) has been shown to improve outcomes for patients with fibromya... more Cognitive behavioural therapy (CBT) has been shown to improve outcomes for patients with fibromyalgia, and its cardinal feature chronic widespread pain (CWP). Prediction models have now been developed which identify groups who are at high-risk of developing CWP. It would be beneficial to be able to prevent the development of CWP in these people because of the high cost of symptoms and because once established they are difficult to manage. We will test the hypothesis that among patients who are identified as at high-risk, a short course of telephone-delivered CBT (tCBT) reduces the onset of CWP. We will further determine the cost-effectiveness of such a preventative intervention. The study will be a two-arm randomised trial testing a course of tCBT against usual care for prevention of CWP. Eligible participants will be identified from a screening questionnaire sent to patients registered at general practices within three Scottish health boards. Those returning questionnaires indicati...
Biobank-type studies are typically large but have very low participation rates. It has been sugge... more Biobank-type studies are typically large but have very low participation rates. It has been suggested that these studies may provide biased estimates of prevalence but are likely to provide valid estimates of association. We test these hypotheses using data collected on pain in a large Biobank study in the United Kingdom. UK Biobank recruited 503,325 persons aged 40-69 years (participation rate 5.5%). Participants completed questionnaires, including pain, lifestyle and environment factors. As a comparison, we used both a large population study of pain (MUSICIAN: n = 8847, aged: 40-69 years) conducted 2008-2009 and the National Child Development study (NCDS) which recruited all persons in Great Britain born during one week of 1958 and followed them up at age 44 years (n = 9377). 'Any pain' (UK Biobank 61.0%; MUSICIAN 63.9%), chronic pain (42.9%, 52.2%) and site-specific musculoskeletal pain (back 26.2%, 29.7%; shoulder/neck 23.3%, 25.3%) were generally similar in UK Biobank a...
To examine whether the prevalence of regional and chronic widespread pain (CWP) varies with rural... more To examine whether the prevalence of regional and chronic widespread pain (CWP) varies with rurality and to determine the characteristics of persons in rural locations in whom pain is found to be in excess. Participants, aged ≥55 years, from participating general practices in seven different geographical locations in Scotland were sent a postal questionnaire. The 1-month prevalence of 10 regional pain conditions plus CWP was identified using body manikins. Differences in the prevalence of pain with differing rurality were examined using Chi(2) test for trend. Thereafter, among the rural population, the relationships between pain and putative risk factors were examined using Poisson regression. Thus, results are described as risk ratios. There was some evidence to suggest that the prevalence of CWP increased with increasing rurality, although the magnitude of this was slight. No large or significant differences were observed with any regional pain conditions. Factors associated with ...
Objectives To understand the impact of the COVID-19 pandemic on access to healthcare services for... more Objectives To understand the impact of the COVID-19 pandemic on access to healthcare services for patients with inflammatory and non-inflammatory MSK conditions. Methods Three established cohorts which included individuals with axial spondyloarthritis, psoriatic arthritis, and musculoskeletal pain completed a questionnaire between July and December 2020. In parallel, a subset of individuals participated in semi-structured interviews. Results 1054 people (45% female, median age 59 years) were included in the quantitative analyses. Qualitative data included 447 free-text questionnaire responses and 23 interviews. 57% respondents had tried to access care since the start of UK national lockdown. Over a quarter reported being unable to book any type of healthcare appointment. GP appointments were less likely to be delayed or cancelled compared with hospital appointments. Younger age, unemployment/health-related retirement, DMARD therapy, anxiety or depression and being extremely clinical...
Objectives: To determine the prevalence of facial pain and to examine the hypothesis that symptom... more Objectives: To determine the prevalence of facial pain and to examine the hypothesis that symptoms are associated with socio-demographic, dental, adverse psychological factors and pain elsewhere in the body. Material and Methods: Cross-sectional population data were obtained from UK Biobank (www.ukbiobank.ac.uk/) study which was conducted in 2006- 2010 and recruited over 500,000 people. Results: The overall prevalence of facial pain (FP) was 1.9 % (women 2.4%, men 1.2%) of which 48 % was chronic. The highest prevalence was found in the 51- 55 age group (2.2%) and the lowest in the 66- 73 age group (1.4%). There was a difference in prevalence by ethnicity (0.8 % and 2.7 % in persons reporting themselves as Chinese and Mixed respectively). Prevalence of FP significantly associated with all measures of social class with the most deprived and on lowest income showing the highest prevalence (2.5 % and 2.4 % respectively). FP was more common in individuals who rated themselves as extremel...
ObjectiveCognitive–behavioural therapy (CBT) has been shown to be effective in the management of ... more ObjectiveCognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk.MethodsA population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT (tCBT). The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EuroQol Questionnaire-five dimensions-five levels/EQ-5D-5L) used as part of a health economic assessment.Results996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were women. At 12 months there was no difference in the onset of CWP (tCBT: 18.0% vs UC: 17.5%; OR ...
Objectives The aim was to develop and validate a simple clinical prediction model, based on easil... more Objectives The aim was to develop and validate a simple clinical prediction model, based on easily collected preoperative information, to identify patients at high risk of pain and functional disability 6 months after total knee arthroplasty (TKA). Methods This was a multicentre cohort study of patients from nine centres across the UK, who were undergoing a primary TKA for OA. Information on sociodemographic, psychosocial, clinical and quality-of-life measures were collected at recruitment. The primary outcome measure for this analysis was the Oxford knee score (OKS), measured 6 months postoperatively by postal questionnaire. Multivariable logistic regression was used to develop the model. Model performance (discrimination and calibration) and internal validity were assessed, and a simple clinical risk score was developed. Results Seven hundred and twenty-one participants (mean age 68.3 years; 53% female) provided data for the present analysis, and 14% had a poor outcome at 6 months...
The current study investigated whether associations between pain and the additional symptoms asso... more The current study investigated whether associations between pain and the additional symptoms associated with fibromyalgia are different in persons with chronic widespread (CWP) compared to multi-site pain (MSP), with or without joint areas. Six studies were utilized: 1958 British birth cohort, EpiFunD, Kid LBP, MUSICIAN, SHAMA and WHEST (females) studies. MSP was defined as the presence of pain in ≥8/≥10 body sites (adults/children) indicated on 4-view body manikins; conducted firstly to include joints (+joints) and secondly without (-joints). The relationship between pain and fatigue, sleep disturbance, somatic symptoms and mood impairment, were assessed using logistic regression. Results are presented as odds ratios (OR), with 95% confidence intervals (CI). There were 34,818 participants across the study populations (adults: mean age range 42-56yrs, % male 43-51 (excluding WHEST), CWP prevalence 12-17%). Amongst those reporting MSP, the proportion reporting CWP ranged between 62-7...
Cognitive behavioural therapy (CBT) has been shown to improve outcomes for patients with fibromya... more Cognitive behavioural therapy (CBT) has been shown to improve outcomes for patients with fibromyalgia, and its cardinal feature chronic widespread pain (CWP). Prediction models have now been developed which identify groups who are at high-risk of developing CWP. It would be beneficial to be able to prevent the development of CWP in these people because of the high cost of symptoms and because once established they are difficult to manage. We will test the hypothesis that among patients who are identified as at high-risk, a short course of telephone-delivered CBT (tCBT) reduces the onset of CWP. We will further determine the cost-effectiveness of such a preventative intervention. The study will be a two-arm randomised trial testing a course of tCBT against usual care for prevention of CWP. Eligible participants will be identified from a screening questionnaire sent to patients registered at general practices within three Scottish health boards. Those returning questionnaires indicati...
Biobank-type studies are typically large but have very low participation rates. It has been sugge... more Biobank-type studies are typically large but have very low participation rates. It has been suggested that these studies may provide biased estimates of prevalence but are likely to provide valid estimates of association. We test these hypotheses using data collected on pain in a large Biobank study in the United Kingdom. UK Biobank recruited 503,325 persons aged 40-69 years (participation rate 5.5%). Participants completed questionnaires, including pain, lifestyle and environment factors. As a comparison, we used both a large population study of pain (MUSICIAN: n = 8847, aged: 40-69 years) conducted 2008-2009 and the National Child Development study (NCDS) which recruited all persons in Great Britain born during one week of 1958 and followed them up at age 44 years (n = 9377). 'Any pain' (UK Biobank 61.0%; MUSICIAN 63.9%), chronic pain (42.9%, 52.2%) and site-specific musculoskeletal pain (back 26.2%, 29.7%; shoulder/neck 23.3%, 25.3%) were generally similar in UK Biobank a...
To examine whether the prevalence of regional and chronic widespread pain (CWP) varies with rural... more To examine whether the prevalence of regional and chronic widespread pain (CWP) varies with rurality and to determine the characteristics of persons in rural locations in whom pain is found to be in excess. Participants, aged ≥55 years, from participating general practices in seven different geographical locations in Scotland were sent a postal questionnaire. The 1-month prevalence of 10 regional pain conditions plus CWP was identified using body manikins. Differences in the prevalence of pain with differing rurality were examined using Chi(2) test for trend. Thereafter, among the rural population, the relationships between pain and putative risk factors were examined using Poisson regression. Thus, results are described as risk ratios. There was some evidence to suggest that the prevalence of CWP increased with increasing rurality, although the magnitude of this was slight. No large or significant differences were observed with any regional pain conditions. Factors associated with ...
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