General practitioners' advice to use topical rather than oral ibuprofen resulted in equivalent effects on chronic knee pain
Bibliographic record
Abstract
ED FROM Underwood M, Ashby D, Carnes D, et al. Topical or oral ibuprofen for chronic knee pain in older people. The TOIB study. Health Technol Assess 2008;12:1–176. Correspondence to: Professor M Underwood, University of Warwick, Coventry, UK; M.Underwood@warwick.ac.uk Sources of funding: Health Technology Assessment Programme; Goldshield Pharmaceuticals supplied starter packs of topical ibuprofen. c Clinical impact ratings: GP/FP/Primary care 6/7; IM/Ambulatory care 6/7; Rheumatology 6/7; Surgery—Orthopaedics 6/7 Advice from general practitioners to use topical v oral ibuprofen for chronic knee pain Baseline scores 12-month scores WOMAC domain* Topical Oral Topical Oral Difference (95% CI){ Pain 39 30 38 36 1 (24 to 6) Stiffness 50 47 46 43 0 (26 to 5) Disability 37 38 39 36 3 (22 to 7) Global assessment 38 39 40 37 2 (22 to 6) *WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index (visual analogue scale, range 0 to 100 [worst]). {Difference in change from baseline, adjusted for baseline values. A positive difference favours oral ibuprofen. CI defined in glossary. C O M M EN TA R Y C ompared with placebo, paracetamol, at doses of 2.6 to 4 g/day, provides a reduction in osteoarthritic pain of modest clinical significance. NSAIDs reduce pain more than paracetamol, especially in severe osteoarthritis, but with increased incidence of gastrointestinal adverse effects. A 2004 systematic review of topical NSAIDs found that they were superior to placebo for osteoarthritis in the first 2 weeks of treatment but not at weeks 3 or 4 (the maximum length of the trials). However, 2 subsequent manufacturer-sponsored trials in patients with knee osteoarthritis showed that topical diclofenac reduced WOMAC pain scores more than placebo at 4 and 12 weeks, respectively. 4 The trial by Underwood et al is the first long-term study comparing an oral with a topical NSAID, ibuprofen. The trial was designed to show equivalence, rather than superiority; the authors concluded that there was no difference in effectiveness. However, the more important finding may be that there was little difference between mean baseline and 12-month WOMAC scores for both preparations (eg, change for global assessment was +2 with topical and -2 with oral ibuprofen). In the absence of a placebo group, it is impossible to conclude whether the 2 treatments were equally mildly effective or equally ineffective. Cristian Baicus, MD Colentina Hospital Bucharest, Romania 1. Towheed TE, Maxwell L, Judd MG, et al. Acetaminophen for osteoarthritis. Cochrane Database Syst Rev 2006;(1):CD004257. 2. Lin J, Zhang W, Jones A, et al. Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials. BMJ 2004;329:324. 3. Bookman AA, Williams KS, Shainhouse JZ. Effect of a topical diclofenac solution for relieving symptoms of primary osteoarthritis of the knee: a randomized controlled trial. CMAJ 2004;171:333–8. 4. Roth SH, Shainhouse JZ. Efficacy and safety of a topical diclofenac solution (pennsaid) in the treatment of primary osteoarthritis of the knee: a randomized, double-blind, vehicle-controlled clinical trial. Arch Intern Med 2004;164:2017–23. Therapeutics 12 EBM February 2009 Vol 14 No 1 on 30 January 2009 ebm.bmj.com Downloaded from
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Editorial About the Canadian research system: no · About a Canadian topic: no | Not applicable | low |
| gpt | no category Domain: not available · Genre: Commentary About the Canadian research system: no · About a Canadian topic: no | Randomized trial | low |
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.011 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.004 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
The models disagree on parts of this classification; every voice is preserved in the section at the end of the page.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".