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Biomedical subjects

J Chard

Publications and source records attributed to J Chard.

13 recordsLinked to original sources
PubMed2001

The case for nonpharmacologic therapy of osteoarthritis.

This paper reviews the most commonly used nonpharmaceutical treatments for osteoarthritis, summarizing the available evidence. Four general areas are reviewed: aids and appliances, exercise and physiotherapy, education and behavioral change, and alternative and complementary therapies. The results of this review indicate that the use of nonpharmaceutical interventions in osteoarthritis is essential for good management of the disease. However, further research is required to improve the evidence base of the use of nonpharmacologic interventions in and the overall management of osteoarthritis.

Complementary Therapies↗
PubMed2000

Relation between agendas of the research community and the research consumer.

BACKGROUND: Previous studies have suggested that research agendas can be biased. To determine whether there is a mismatch between available research evidence and the research preferences of consumers we examined research on interventions for the treatment of osteoarthritis of the knee joint. METHODS: We searched published and unpublished studies on interventions in this condition to assess the structure of the evidence base. Focus groups and a postal survey of research consumers were then undertaken to examine their views and research priorities. FINDINGS: Review of published and unpublished reports showed that the evidence base was dominated by studies of pharmaceutical (550, 59%) and surgical (238, 26%) interventions. 24 (36%) of 67 survey respondents ranked knee replacement as the highest priority for research, whereas 14 (21%) chose education and advice as their first choice. INTERPRETATION: There is a mismatch between the amount of published work on different interventions, and the degree of interest of consumers. We suggest that broadening of the research agenda would be more in line with current treatment patterns and consumer views. If this mismatch is not addressed, then evidence-based medicine will not be representative of consumer needs.

Acupuncture Therapy↗
PubMed2000

Exploring the priorities of patients with osteoarthritis of the knee.

OBJECTIVE: To explore the perceived importance of symptoms, treatment preferences, and research priorities of people with osteoarthritis (OA) of the knee. METHODS: Results of a focus group were used to facilitate the design of a questionnaire, distributed to 112 people with knee OA. RESULTS: Pain, disability, and instability in the joint were the most important symptoms, and anxiety about knee OA caused distress to many people. Oral drugs (90%), physical therapy (62%), and aids and adaptations (56%) were the most commonly used treatments. Surgery, oral drugs, and intra-articular injections were perceived as the most efficacious interventions. Patients' highest priorities for research were surgery and educational interventions, despite the fact that few had had surgery and education was not perceived as very effective. CONCLUSIONS: The lack of a patient-centered approach to care leads professionals to ignore key symptoms and issues for individuals, and to a preoccupation with pharmaceutical interventions, rather than the treatment options that their patients prefer.

Activities of Daily Living↗
PubMed1999

Commissioning health services research: an iterative method.

The standard linear method of commissioning research involves many stages, some lengthy. While assessment criteria are usually explicit, their weighting and interaction are not. Output is assessed on completion. This method is suitable where the research question is clear-cut. However, it has drawbacks when the research question and the form and scope of the research are not clear at the outset, as is often the case with research on the delivery and organisation of services. Also, it does not encourage potential users of the research to develop a sense of ownership. An alternative method is proposed by which the scope, form and content of research are not specified in advance but are developed iteratively. A programme director, advised by a group of potential users and research commissioners, has devolved authority to commit funding for the stages of the work as it unfolds, predicated on evolving need. There are foreseeable but avoidable risks of the group over-identifying with the researchers, of research management becoming cumbersome, and of unproductive friction between research groups when they are required to work together. The iterative method, being new and untried, is itself an organisational change requiring evaluation. However, from our local experience, it provides for productive dialogue between research commissioners, researchers and potential users.

Health Services Research↗