Abstract:
OBJECTIVE:To investigate the effectiveness of supplementing information and advice on analgesia and exercise from a general practitioner with transcutaneous electrical nerve stimulation (TENS) as a non-drug form of analgesia to reduce pain intensity in patients with tennis elbow. DESIGN:Pragmatic randomised controlled trial in primary care. SETTING AND:38 general practices in the West Midlands, UK. PARTICIPANTS:241 adults consulting with a first or new (no consultation in previous six months) clinical diagnosis of tennis elbow. INTERVENTIONS:Participants were randomly allocated to either primary care management alone, consisting of a consultation with a general practitioner followed by information and advice on exercises, or primary care management plus TENS to be used once a day for 45 minutes over six weeks (or until symptom resolution) for pain relief. OUTCOME MEASURES:The primary outcome was self reported intensity of elbow pain (0-10 rating scale) at six weeks. Primary and secondary outcomes were measured at baseline and at six weeks, six months, and 12 months by postal questionnaire. Analysis was by intention to treat. RESULTS:121 participants were randomised to primary care management plus TENS and 120 to primary care management only (first episode, n=197 (82%); duration <1-3 months, n=138 (57%)). Adherence to exercise and TENS recommendations reported at six weeks was low; only 42 participants in the primary care management plus TENS group met a priori defined adherence criteria. Both intervention groups showed large improvements in pain and secondary outcomes, especially during the first six weeks of follow-up. However, no clinically or statistically significant differences were seen between groups at any follow-up timepoint. At the primary endpoint (six weeks), the between group difference in improvement of pain was -0.33 (95% confidence interval -0.96 to 0.31; P=0.31) in favour of the primary care management only group, with adjustment for age, sex, and baseline pain score. CONCLUSIONS:This trial does not provide evidence for additional benefit of TENS as an adjunct to primary care management of tennis elbow. Poor adherence to interventions is evidence of the challenges of implementing self management treatment strategies in primary care. TRIAL REGISTRATION:Current Controlled Trials ISRCTN87141084.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Chesterton LS,Lewis AM,Sim J,Mallen CD,Mason EE,Hay EM,van der Windt DAdoi
10.1136/bmj.f5160subject
Has Abstractpub_date
2013-09-02 00:00:00pages
f5160eissn
0959-8138issn
1756-1833journal_volume
347pub_type
杂志文章,随机对照试验abstract:OBJECTIVE:To assess the impact of Stepping Stones, a HIV prevention programme, on incidence of HIV and herpes simplex type 2 (HSV-2) and sexual behaviour. DESIGN:Cluster randomised controlled trial. SETTING:70 villages (clusters) in the Eastern Cape province of South Africa. PARTICIPANTS:1360 men and 1416 women aged...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.a506
更新日期:2008-08-07 00:00:00
abstract:OBJECTIVES:To explore the assumptions underlying consumers' responses to questions of resource priorities in the NHS. DESIGN:Qualitative analysis of semi-structured interviews with a heterogeneous sample of 16 patients drawn from a general practice. RESULTS:Interviewees were not persuaded that they had a legitimate r...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.7013.1137
更新日期:1995-10-28 00:00:00
abstract:OBJECTIVE:To evaluate the effects of a multifaceted empowerment strategy on the actual use of single embryo transfer after in vitro fertilisation. DESIGN:Randomised controlled trial. SETTING:Five in vitro fertilisation clinics in the Netherlands. PARTICIPANTS:308 couples (women aged <40) on the waiting list for a fi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.c2501
更新日期:2010-09-30 00:00:00
abstract:OBJECTIVE:To identify and explore parents' concerns when young children become acutely ill. DESIGN:Qualitative study making use of semi-structured one to one and group interviews with parents of preschool children. SETTING:Disadvantaged inner city community. SUBJECTS:95 parents of preschool children. RESULTS:Fever,...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7063.983
更新日期:1996-10-19 00:00:00
abstract:OBJECTIVE:To examine changes in immunisation performance in Grampian region after the introduction of the 1990 contract for general practitioners. DESIGN:Retrospective descriptive study using data held on the Grampian immunisation record system's computer. SETTING:All 95 general practices in Grampian region (313 gene...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6830.816
更新日期:1992-03-28 00:00:00
abstract:OBJECTIVE:To assess the efficacy of a newly developed system for applying continuous or intermittent negative (subatmospheric) extrathoracic pressure in respiratory failure. DESIGN:Uncontrolled clinical trials in infants deteriorating or failing to improve despite standard medical treatment. SETTING:Paediatric and ne...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.299.6710.1253
更新日期:1989-11-18 00:00:00
abstract::With the aim of promoting the informed choice of pregnant women, staff and pregnant women at two urban hospitals were offered leaflets summarising the best available evidence about the effectiveness of routine ultrasonography in early pregnancy. Ultrasonographers doubted the credibility of the evidence and were concer...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7067.1251a
更新日期:1996-11-16 00:00:00
abstract:OBJECTIVE:To evaluate systematically the review literature on type 2 diabetes to assess transmission of the findings of the United Kingdom prospective diabetes study (UKPDS), an important source of recent valid patient oriented evidence that matters (POEMs). DESIGN:Inception cohort analysis of the recent medical liter...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.327.7409.266
更新日期:2003-08-02 00:00:00
abstract::Objective To estimate the incidence and prevalence of resistant hypertension among a UK population treated for hypertension from 1995 to 2015.Design Cohort study.Setting Electronic health records from the UK Clinical Practice Research Datalink in primary care.Participants 1 317 290 users of antihypertensive drugs with...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j3984
更新日期:2017-09-22 00:00:00
abstract:OBJECTIVE:To assess whether customised mobile phone reminders would improve adherence to therapy and thus decrease virological failure among HIV infected patients starting antiretroviral treatment (ART). DESIGN:Randomised controlled trial among HIV infected patients initiating antiretroviral treatment. SETTING:Three ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.g5978
更新日期:2014-10-24 00:00:00
abstract:OBJECTIVE:To examine the association between obstetric epidural anaesthesia and subsequent long term problems. DESIGN:Postal questionnaire on health problems after childbirth linked to maternity case note data. SETTING:Maternity hospital in Birmingham. SUBJECTS:11701 women who delivered their most recent child durin...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6837.1279
更新日期:1992-05-16 00:00:00
abstract:OBJECTIVE:To gain detailed understanding of influences on smoking behaviour in Bangladeshi and Pakistani communities in the United Kingdom to inform the development of effective and culturally acceptable smoking cessation interventions. DESIGN:Qualitative study using community participatory methods, purposeful samplin...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.326.7396.962
更新日期:2003-05-03 00:00:00
abstract:OBJECTIVE:To identify the nature and extent of any vocational training deficit within the London initiative zone and investigate the reasons. DESIGN:Collation of statistics and postal questionnaire surveys. SETTING:Thames regions inside and outside the London initiative zone. SUBJECTS:General practice registrars, tr...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7023.97
更新日期:1996-01-13 00:00:00
abstract:OBJECTIVE:To investigate the results of resuscitation of patients with cardiac arrest by ambulance staff with extended training in West Yorkshire. DESIGN:Study of all such attempts at resuscitation over 32 months, based on the standard report form for each call made by the ambulance staff and the electrocardiogram tha...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.301.6752.600
更新日期:1990-09-22 00:00:00
abstract::Research in general practice is becoming increasingly popular, and most general practitioners will sooner or later have to decide whether to become involved with clinical trials sponsored by drug companies. This paper outlines the advantages and disadvantages of multicentre research--based on experience of running a r...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6915.1331
更新日期:1993-11-20 00:00:00
abstract:OBJECTIVE:To determine the risk factors for neonatal encephalopathy among term infants in a developing country. DESIGN:Unmatched case-control study. SETTING:Principal maternity hospital of Kathmandu, Nepal. SUBJECTS:All 131 infants with neonatal encephalopathy from a population of 21 609 infants born over an 18 mont...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.320.7244.1229
更新日期:2000-05-06 00:00:00
abstract::In the existing WHO guidelines, complementary feeding at 4-6 months is advocated. However, many nutrition specialists believe that these guidelines lead to complementary foods being offered from the age of 3 months, or even earlier, subsequently suggesting that the WHO should change its recommendations to about 6 mon...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:
更新日期:2000-09-09 00:00:00
abstract:OBJECTIVE:To assess the effect of high dose inhaled corticosteroids on skin. DESIGN:Cross sectional study of patients receiving treatment for chest diseases. SETTING:Outpatient chest clinic in a teaching hospital. PATIENTS:68 Patients divided into four groups of similar age--namely, 15 receiving long term oral predn...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6739.1548
更新日期:1990-06-16 00:00:00
abstract:OBJECTIVE:To compare the rate of moderate to severe exacerbations between triple therapy and dual therapy or monotherapy in patients with chronic obstructive pulmonary disease (COPD). DESIGN:Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES:PubMed, Embase, Cochrane databases, and clini...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.k4388
更新日期:2018-11-06 00:00:00
abstract:OBJECTIVE:To assess the association between genitourinary infections in the month before conception to the end of the first trimesterand gastroschisis. DESIGN:Case-control study with self reported infections from a computer assisted telephone interview. SETTING:National birth defects prevention study, a multisite, po...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.39567.509074.25
更新日期:2008-06-21 00:00:00
abstract::The aim of the study was to determine the outcome in 181 diabetic patients with advanced, previously untreated renal impairment who had been identified in a survey conducted in six health regions in the United Kingdom in 1985. Late in 1987 questionnaires were sent to the consultant physicians, geriatricians, and nephr...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6708.1135
更新日期:1989-11-04 00:00:00
abstract:OBJECTIVE:To conduct a systematic review and meta-analysis of cohort studies of body mass index (BMI) and the risk of all cause mortality, and to clarify the shape and the nadir of the dose-response curve, and the influence on the results of confounding from smoking, weight loss associated with disease, and preclinical...
journal_title:BMJ (Clinical research ed.)
pub_type: 评论,杂志文章
doi:10.1136/bmj.i2156
更新日期:2016-05-04 00:00:00
abstract:OBJECTIVE:To explore the hypothesis that different methods of selecting and printing information for cancer patients could improve emotional support by affecting interaction with others, and so lead to improved psychological wellbeing. DESIGN:Randomised trial with eight groups (three factors, 2x2x2). Data collected at...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.38807.571042.68
更新日期:2006-04-22 00:00:00
abstract::In a one year prospective study within the Trent Regional Health Authority the demand for neonatal intensive care was estimated to be 1.1 cots per 1000 births. Intensive care level 1 (as defined by the British Paediatric Association and British Association for Perinatal Paediatrics) was determined by two separate tech...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6711.1305
更新日期:1989-11-25 00:00:00
abstract:OBJECTIVES:To assess the feasibility and effectiveness of a general practice based, proactive system of asthma care in children. DESIGN:Randomised controlled trial with cluster sampling by general practice. SETTING:General practices in the northern region of the Australian Capital Territory. PARTICIPANTS:174 childre...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.327.7416.659
更新日期:2003-09-20 00:00:00
abstract:OBJECTIVE:To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman's reproductive history. DESIGN:Prospective register linkage study. SUBJECTS:All women with a reproductive outcome (live birth, stillbirth, spontaneous abortion ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.320.7251.1708
更新日期:2000-06-24 00:00:00
abstract:OBJECTIVES:To estimate the cost effectiveness of statins in lowering serum cholesterol concentration in people at varying risk of fatal cardiovascular disease and to explore the implications of changing the criteria for intervention on cost and cost effectiveness for a purchasing authority. DESIGN:A life table method ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7044.1443
更新日期:1996-06-08 00:00:00
abstract:OBJECTIVE:To assess whether sleep apnoea syndrome is an independent risk factor for hypertension. DESIGN:Population study. SETTING:Sleep clinic in Toronto. PARTICIPANTS:2,677 adults, aged 20-85 years, referred to the sleep clinic with suspected sleep apnoea syndrome. OUTCOME MEASURES:Medical history, demographic da...
journal_title:BMJ (Clinical research ed.)
pub_type: 评论,杂志文章
doi:10.1136/bmj.320.7233.479
更新日期:2000-02-19 00:00:00
abstract::First aid, as a profession in its own right, has a history of only 120 years. It evolved from the teachings of the Royal Humane Society and military surgeons, who saw the wisdom of training in splinting and bandaging for battlefield wounds. In 1878 two Aberdeenshire military officers, Surgeon-Major Peter Shepherd of t...
journal_title:BMJ (Clinical research ed.)
pub_type: 传,历史文章,杂志文章
doi:10.1136/bmj.309.6970.1718
更新日期:1994-12-24 00:00:00
abstract:OBJECTIVE:To establish the extent to which systematic reviews and meta-analyses of individual participant data (IPD) are being used to inform the recommendations included in published clinical guidelines. DESIGN:Descriptive study. SETTING:Database maintained by the Cochrane IPD Meta-analysis Methods Group, supplement...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.h1088
更新日期:2015-03-06 00:00:00