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STOPS trial versus Costa et al: a more accurate analysis
Ist Teil von
British journal of sports medicine, 2019-07, Vol.53 (14), p.914-916
Ort / Verlag
England: BMJ Publishing Group LTD
Erscheinungsjahr
2019
Link zum Volltext
Quelle
BMJ Journals
Beschreibungen/Notizen
[...]at 1-year follow-up, the STOPS advice group may have had superior outcomes compared with the Costa et al participants, given the entire 95% CI for this STOPS data point falls below the Costa et al trendline (figure 2). On the basis of a scientifically appropriate and accurate interpretation of the Costa et al meta-analysis, it is clear that the proposition that the STOPS recovery trajectories are worse than expected is wrong. [...]questioning the conclusions of the STOPS trial on the basis of these data is not appropriate. Guidelines recommend advice as a primary treatment for acute and subacute LBD8 despite limited or conflicting evidence.9 Our sample could be best described as subacute, and in this population the RCT investigating advice with the largest effects included a pathoanatomical explanation.10 Given this evidence of effectiveness, we based the STOPS advice intervention on the Indahl et al protocol.10 While it is possible that a pathoanatomical explanation may result in adverse outcomes, data to support this proposition are sparse11 12 or have a high risk of bias.13 The outcomes from other trials that have used advice without a pathoanatomical explanation14 are worse than those reported in the STOPS trial or the original trial by Indahl et al. [...]this approach is consistent with recent high-quality clinical guidelines.18 Finally with our RCT design, we would like to emphasise that both groups received the same advice intervention. [...]the between-group differences were due to the individualised physiotherapy rather than the advice component.