Browsing by Author "Booth, Marika"
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- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain Systematic Review and Meta-analysisMorton, Sally C.; Paige, Neil M.; Miake-Lye, Isomi M.; Booth, Marika; Beroes, Jessica M.; Mardian, Aram S.; Dougherty, Paul; Branson, Richard; Tang, Baron (American Medical Association, 2017-04-11)IMPORTANCE Acute low back pain is common and spinal manipulative therapy (SMT) is a treatment option. Randomized clinical trials (RCTs) and meta-analyses have reported different conclusions about the effectiveness of SMT. OBJECTIVE To systematically review studies of the effectiveness and harms of SMT for acute ( 6 weeks) low back pain. DATA SOURCES Search of MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, and Current Nursing and Allied Health Literature from January 1, 2011, through February 6, 2017, as well as identified systematic reviews and RCTs, for RCTs of adults with low back pain treated in ambulatory settings with SMT compared with sham or alternative treatments, and that measured pain or function outcomes for up to 6 weeks. Observational studies were included to assess harms. DATA EXTRACTION AND SYNTHESIS Data extractionwas done in duplicate. Study qualitywas assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool. This tool has 11 items in the following domains: randomization, concealment, baseline differences, blinding (patient), blinding (care provider [care provider is a specific qualitymetric used by the CBN Risk of Bias tool]), blinding (outcome), co-interventions, compliance, dropouts, timing, and intention to treat. Prior research has shown the CBN Risk of Bias tool identifies studies at an increased risk of bias using a threshold of 5 or 6 as a summary score. The evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. MAIN OUTCOMES AND MEASURES Pain (measured by either the 100-mm visual analog scale, 11-point numeric rating scale, or other numeric pain scale), function (measured by the 24-point Roland Morris Disability Questionnaire or Oswestry Disability Index [range, 0-100]), or any harms measured within 6 weeks. FINDINGS Of 26 eligible RCTs identified, 15 RCTs (1711 patients) provided moderate-quality evidence that SMT has a statistically significant association with improvements in pain (pooled mean improvement in the 100-mm visual analog pain scale, −9.95 [95%CI, −15.6 to −4.3]). Twelve RCTs (1381 patients) produced moderate-quality evidence that SMT has a statistically significant association with improvements in function (pooled mean effect size, −0.39 [95%CI, −0.71 to −0.07]). Heterogeneity was not explained by type of clinician performing SMT, type of manipulation, study quality, or whether SMT was given alone or as part of a package of therapies. No RCT reported any serious adverse event. Minor transient adverse events such as increased pain, muscle stiffness, and headache were reported 50% to 67%of the time in large case series of patients treated with SMT. CONCLUSIONS AND RELEVANCE Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large.
- Economic Evaluation of Quality Improvement Interventions Designed to Prevent Hospital Readmission A Systematic Review and Meta-analysisMorton, Sally C.; Nuckols, Teryl K.; Keeler, Emmett B.; Anderson, Laura J.; Doyle, Brian J.; Pevnick, Joshua; Booth, Marika; Shanman, Roberta; Arifkhanova, Aziza; Shekelle, Paul G. (AMA, 2017-05-30)IMPORTANCE Quality improvement (QI) interventions can reduce hospital readmission, but little is known about their economic value. OBJECTIVE To systematically review economic evaluations of QI interventions designed to reduce readmissions. DATA SOURCES Databases searched included PubMed, Econlit, the Centre for Reviews & Dissemination Economic Evaluations, New York Academy of Medicine's Grey Literature Report, andWorldcat (January 2004 to July 2016). STUDY SELECTION Dual reviewers selected English-language studies from high-income countries that evaluated organizational or structural changes to reduce hospital readmission, and that reported program and readmission-related costs. DATA EXTRACTION AND SYNTHESIS Dual reviewers extracted intervention characteristics, study design, clinical effectiveness, study quality, economic perspective, and costs.We calculated the risk difference and net costs to the health system in 2015 US dollars.Weighted least-squares regression analyses tested predictors of the risk difference and net costs. MAIN OUTCOMES AND MEASURES Main outcomes measures included the risk difference in readmission rates and incremental net cost. This systematic review and data analysis is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTS Of 5205 articles, 50 unique studies were eligible, including 25 studies in populations limited to heart failure (HF) that included 5768 patients, 21 in general populations that included 10 445 patients, and 4 in unique populations. Fifteen studies lasted up to 30 days while most others lasted 6 to 24 months. Based on regression analyses, readmissions declined by an average of 12.1% among patients with HF (95%CI, 8.3%-15.9%; P < .001; based on 22 studies with complete data) and by 6.3%among general populations (95%CI, 4.0%-8.7%; P < .001; 18 studies). The mean net savings to the health system per patient was $972 among patients with HF (95%CI, −$642 to $2586; P = .23; 24 studies), and the mean net loss was $169 among general populations (95%CI, −$2610 to $2949; P = .90; 21 studies), reflecting nonsignificant differences. Among general populations, interventions that engaged patients and caregivers were associated with greater net savings ($1714 vs −$6568; P = .006). CONCLUSIONS AND RELEVANCE Multicomponent QI interventions can be effective at reducing readmissions relative to the status quo, but net costs vary. Interventions that engage general populations of patients and their caregivers may offer greater value to the health system, but the implications for patients and caregivers are unknown.