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    How can we design low back pain intervention studies to better explain the effects of treatment?

    Access Status
    Fulltext not available
    Authors
    Mansell, G.
    Hill, J.
    Kamper, S.
    Kent, Peter
    Main, C.
    van Der Windt, D.
    Date
    2014
    Type
    Journal Article
    
    Metadata
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    Citation
    Mansell, G. and Hill, J. and Kamper, S. and Kent, P. and Main, C. and van Der Windt, D. 2014. How can we design low back pain intervention studies to better explain the effects of treatment? Spine. 39 (5): pp. E305-E310.
    Source Title
    Spine
    DOI
    10.1097/BRS.0000000000000144
    ISSN
    0362-2436
    School
    School of Physiotherapy and Exercise Science
    URI
    http://hdl.handle.net/20.500.11937/54746
    Collection
    • Curtin Research Publications
    Abstract

    The majority of trials investigating the effectiveness of primary care interventions for back pain have shown small or at best, moderate effects of treatment 36 , 37 and the fi eld is looking for better ways to improve outcomes for patients with back pain. Mediation analysis aims to provide better insight into the causal pathways underlying treatment effects, explaining why treatments work or do not work and potentially offering new opportunities to improve patient outcomes by optimizing the content or delivery of treatment. Until recently, mediation analysis in clinical research was often limited to a descriptive evaluation of the processes potentially underlying the effects of treatment in trials. 38 , 39 During the past few years, interest in the use of more sophisticated approaches to mediation analysis has increased, often guided by methods described in the psychological literature. In this article, we have summarized the concepts and different designs used in mediation analysis and explained the importance of experimental designs when investigating mediators of treatment effect. We have also emphasized the importance of other considerations such as defi ning and understanding constructs, selecting study measures with appropriate measurement properties, and ensuring study measurement time points are appropriately selected, to investigate the longitudinal associations between mediating and outcome variables. We have also outlined the relevance of observational and qualitative research in identifying potential mediating factors. On the basis of the discussions during the 2012 workshop and supported by the literature, we have proposed a set of recommendations to support and improve the design of mediation analysis in back pain research (Box 1), with the ultimate aim to improve the design and delivery of intervention studies and optimize outcomes for patients with back pain. © 2014 Lippincott Williams and Wilkins.

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