P. Schluter

Quantifying the effect of a community-based injury prevention program in Queensland using a generalized estimating equation approach

Objective: To develop a generalized estimating equation (GEE) model of childhood injury rates to quantify the effectiveness of a community-based injury prevention program implemented in 2 communities in Australia, in order to contribute to the discussion of community-based injury prevention program evaluation. Design: An ecological study was conducted comparing injury rates in two intervention communities in rural and remote Queensland, Australia, with those of 16 control regions. A model of childhood injury was built using hospitalization injury rate data from 1 July 1991 to 30 June 2005 and 16 social variables. The model was built using GEE analysis and was used to estimate parameters and to test the effectiveness of the intervention. Results: When social variables were controlled for, the intervention was associated with a decrease of 0.09 injuries/10 000 children aged 0–4 years (95% CI −0.29 to 0.11) in logarithmically transformed injury rates; however, this decrease was not significant (p = 0.36). Conclusions: The evaluation methods proposed in this study provide a way of determining the effectiveness of a community-based injury prevention program while considering the effect of baseline differences and secular changes in social variables.

The Ausback study: an audit of low back pain outcomes in Australian musculoskeletal medicine practices

Abstract Background: The major influences on musculoskeletal medicine practitioners in Australia in the last 20 years have been from an eclectic mix of local and international experts and evidence from many disciplines. This has resulted in practitioners with a multimodal approach that combines evidence with pragmatism. The effectiveness of this combined approach on Australian patients with low back pain needs testing to see if it has broader application. Objectives: This study aimed to measure the effectiveness of a multimodal approach practiced by musculoskeletal medicine practitioners in a private clinic setting supported by a referral network of allied health professionals. Patients and Methods: This non-randomised, non-consecutive audit comprised 75 patients with low back pain with or without leg pain from three musculoskeletal medicine practices in Queensland, Australia. Pain, disability, general health and global response were followed in participants for 6 months. Results: For this cohort, the mean ± SD age was 45 ± years and the median duration of low back pain was 4 years (IQR, 0.5–8 years). The follow-up rate at 6 months was 75%. Clinically and statistically significant reductions in mean scores from baseline to 6 months were noted for pain from 5.5 (95% confidence interval [CI], 5.0–6.0) to 2.9 (95% CI, 2.3–3.5) at 6 months and for Roland–Morris disability questionnaire from 12.2 (95% CI, 11.0–13.3) to 7.7 (95% CI, 6.2–9.2). At 6 months, 51% were much improved or very much improved. Better reductions in pain and disability were noted in subgroups that were not working, that had pain duration up to 3 months and a past history of one to two episodes of low back pain. Conclusions: The improvements in pain and disability at 6 months observed in this study were similar to those observed for other conservative treatment methods for chronic low back pain.