Accuracy of Smartphone Applications and Wearable Devices for Tracking Physical Activity Data Despite the potential of pedometers to increase physical activity and improve health,1 there is little evidence of broad adoption by the general population. In contrast, nearly twothirds of adults in the United States own a smartphone2 and technology advancements have enabled these devices to track health behaviors such as physical activity and provide convenient feedback.3 New wearable devices that may have more consumer appeal have also been developed. Even though these devices and applications might better engage individuals in their health, for example through workplace wellness programs,3 there has been little evaluation of their use.3-5 The objective of this study was to evaluate the accuracy of smartphone applications and wearable devices compared with direct observation of step counts, a metric successfully used in interventions to improve clinical outcomes.1

https://jamanetwork.com/journals/jama/articlepdf/2108876/jld140043.pdf

Accuracy of smartphone applications and wearable devices for tracking physical activity data.

https://www.zora.uzh.ch/id/eprint/144283/1/Vickers_J_Pain_2017.pdf

Acupuncture for chronic pain: update of an individual patient data meta-analysis

When assessing the clinical utility of therapies intended to improve subjective outcomes, the amount of improvement that is important to patients must be determined.1 The smallest benefit of value to patients is called the minimal clinically important difference (MCID). The MCID is a patient-centered concept, capturing both the magnitude of the improvement and also the value patients place on the change. Using patientcentered MCIDs is important for studies involving patientreported outcomes,2 for which the clinical importance of a given change may not be obvious to clinicians selecting treatments. The MCID defines the smallest amount an outcomemust change to be meaningful to patients.1 In this issue of JAMA, Hinmanet al3 report findings froma clinical trial evaluatingwhether acupuncture (needle, laser, andsham laser) improved pain or overall functional outcomes compared with no acupuncture among patients with chronic knee pain. Pain was measured on a numerical rating scale and functional status by the Western andMcMasterUniversitiesOsteoarthritis Index (WOMAC) score. The MCIDs for both end points were based on prior experience with these scoring systems. The MCID for pain was determined using an expert consensus, or Delphi approach,4 while the MCID for function was determined using an “anchor” approach, based on patients’ qualitative assessments of their own responses to treatment.5

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=1910090&pdfFileName=jgm140006.pdf

Minimal Clinically Important Difference: Defining What Really Matters to Patients

Objective To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears.

Design Randomised controlled superiority trial.

Setting Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway.

Participants 140 adults, mean age 49.5 years (range 35.7–59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis.

Interventions 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone.

Main outcome measures Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months.

Results No clinically relevant difference was found between the two groups in change in KOOS4 at two years (0.9 points, 95% confidence interval −4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit.

Conclusion The observed difference in treatment effect was minute after two years of follow-up, and the trial's inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.

Trial registration [www.clinicaltrials.gov][1] ([NCT01002794][2]).

 [1]: http://www.clinicaltrials.gov
 [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01002794&atom=%2Fbjsports%2F50%2F23%2F1473.atom

https://www.bmj.com/content/bmj/354/bmj.i3740.full.pdf

Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up

RESULTS At 12 weeks and 1 year, 26 (9%) and 50 (18%) participants were lost to follow-up, respectively. Analyses showed neither needle nor laser acupuncture significantly improved pain (mean difference; −0.4 units; 95% CI, −1.2 to 0.4, and −0.1; 95% CI, −0.9 to 0.7, respectively) or function (−1.7; 95% CI, −6.1 to 2.6, and 0.5; 95% CI, −3.4 to 4.4, respectively) compared with sham at 12 weeks. Compared with control, needle and laser acupuncture resulted in modest improvements in pain (−1.1; 95% CI, −1.8 to −0.4, and −0.8; 95% CI, −1.5 to −0.1, respectively) at 12 weeks, but not at 1 year. Needle acupuncture resulted in modest improvement in function compared with control at 12 weeks (−3.9; 95% CI, −7.7 to −0.2) but was not significantly different from sham (−1.7; 95% CI, −6.1 to 2.6) and was not maintained at 1 year. There were no differences for most secondary outcomes and no serious adverse events.

/pdf/acupuncture-for-chronic-knee-pain-a-randomized-clinical-1jc7mvu6ee.pdf

Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial

Chronic knee pain is a common and disabling condition in people over 50 years of age, with knee joint osteoarthritis being a major cause. Acupuncture is a popular form of complementary and alternative medicine for treating pain and dysfunction associated with musculoskeletal conditions. This pragmatic Zelen-design randomised controlled trial is investigating the efficacy and cost-effectiveness of needle and laser acupuncture, administered by medical practitioners, in people with chronic knee pain. Two hundred and eighty two people aged over 50 years with chronic knee pain have been recruited from metropolitan Melbourne and regional Victoria, Australia. Participants originally consented to participate in a longitudinal natural history study but were then covertly randomised into one of four treatment groups. One group continued as originally consented (ie natural history group) and received no acupuncture treatment. The other three were treatment groups: i) laser acupuncture, ii) sham laser or, iii) needle acupuncture. Acupuncture treatments used a combined Western and Traditional Chinese Medicine style, were delivered by general practitioners and comprised 8–12 visits over 12 weeks. Follow-up is currently ongoing. The primary outcomes are pain measured by an 11-point numeric rating scale (NRS) and self-reported physical function measured by the Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Index subscale at the completion of treatment at 12 weeks. Secondary outcomes include quality of life, global rating of change scores and additional measures of pain (other NRS and WOMAC subscale) and physical function (NRS). Additional parameters include a range of psychosocial measures in order to evaluate potential relationships with acupuncture treatment outcomes. Relative cost-effectiveness will be determined from health service usage and outcome data. Follow-up assessments will also occur at 12 months. The findings from this study will help determine whether laser and/or needle acupuncture is efficacious, and cost-effective, in the management of chronic knee pain in older people. Australian New Zealand Clinical Trials Registry reference: ACTRN12609001001280

/pdf/efficacy-of-acupuncture-for-chronic-knee-pain-protocol-for-a-4nbta8i9bk.pdf

Efficacy of acupuncture for chronic knee pain: protocol for a randomised controlled trial using a Zelen design.

Low-level laser therapy has evidence accumulating about its effectiveness in a variety of medical conditions. We reviewed 51 double blind randomized controlled trials (RCTs) of laser treatment. Analysis revealed 58% of trials showed benefit of laser over placebo. However, less than 5% of the trials had addressed beam disguise or allocation concealment in the laser machines used. Many of the trials used blinding methods that rely on staff cooperation and are therefore open to interference or bias. This indicates significant deficiencies in laser trial methodology. We report the development and preliminary testing of a novel laser machine that can blind both patient and operator to treatment allocation without staff participation. The new laser machine combines sealed preset and non-bypassable randomization codes, decoy lights and sound, and a conical perspex tip to overcome laser diode glow detection.

/pdf/blinding-techniques-in-randomized-controlled-trials-of-laser-3avtwdk5ot.pdf

Ian Relf

Papers

Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial

Efficacy of acupuncture for chronic knee pain: protocol for a randomised controlled trial using a Zelen design.

Blinding techniques in randomized controlled trials of laser therapy: an overview and possible solution.