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Financial Incentives to Patients Improve Smoking Quit Rates
INFOPOEMS
Study Design Meta-analysis (randomized controlled trials) Funding Unknown/not stated Setting Various (meta-analysis) Synopsis In spite of guidelines and individual studies demonstrating that early imaging does not improve outcomes in patients with low-back pain in the absence of red flags suggesting serious underlying pathology, it is still common for physicians to perform x-rays in patients without any real indication. These authors systematically searched Medline and the Cochrane Clinical Trials Register for randomized trials that compared early imaging with routine clinical care without imaging in patients with low-back pain who lacked red flags. Two reviewers independently determined whether studies should be included, assessed study quality, and extracted data. They resolved discrepancies by consensus. They identified 6 trials with approximately 1800 patients and follow-ups between 3 weeks and 2 years. Four studies compared x-rays with usual care, 1 compared MRI or CT with usual care, and in 1 study all patients had MRI but whether the results were provided was randomly assigned. In all the studies, regardless of length of follow-up, there was no difference in pain, function, disability, or quality of life. Reference
Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373(9662):463472.
Financial Incentives to Patients Improve Smoking Quit Rates Clinical Question Do f inancial incentives for patients improve their success with smoking cessation? Bottom Line It pays to quit smoking. Literally. Patients who received up to $750 in financial incentives were much more likely to be abstinent from tobacco at 9 months to 12 months than were those not receiving such an incentive (number needed to treat [NNT] = 10). (LOE = 1b) Study Design Randomized controlled trial (nonblinded) Funding Government Allocation Concealed Setting Population-based Synopsis Adults who smoked at least 5 cigarettes per day from several work sites of a large corporation were randomized to financial incentives or no financial incentives. The incentives included $100 to attend a community-based smoking cessation program, $250 to be abstinent at 3 to 6 months (confirmed by cotinine levels), and another $400 to be abstinent at 9 to 12 months. Patients in the nonincentivized group were able to attend the program but received no compensation for having quit smoking. The mean age of participants was 45 years, 65% were men, and the mean cigarettes per day was 20; they had also made an average of 6 previous attempts to quit. Of 878 randomized participants, approximately 25% in each group withdrew or were lost to follow-up during the study period. Par-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
ticipation in the smoking cessation program was greater in the incentive group (15.4% vs 5.4%; P < .001) as was confirmed abstinence at 9 months to 12 months (14.7% vs 5.0%; P < .001; NNT = 10).
Reference
Volpp KG, Troxel AB, Pauly MV, et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 2009;360(7):699-709.
Bursa Injection No Better Than Systemic Steroid for Rotator Cuff Clinical Question Is shoulder injection of a corticosteroid more effective than systemic steroid therapy in patients with rotator cuff disease? Bottom Line Subacromial bursa injection, even under ultrasound guidance, provides no better pain and movement relief than an injection of the same amount of corticosteroid (triamcinolone, 20 mg) into the upper gluteal region. Since all patients received both a gluteal and shoulder injection, there is the possibility of an additional placebo effect of an injection “where it hurts.” (LOE = 1b-) Study Design Randomized controlled trial (double-blinded) Funding Self-funded or unfunded Allocation Concealed Setting Outpatient (primary care) Synopsis To determine the effectiveness of a subacromial bursa injection of corticosteroid, these Norwegian investigators recruited 106 patients from general practices with rotator cuff pain lasting at least 3 months, VOL. 101, NO. 6, JUNE 2009 629
Study Design Meta-analysis (randomized controlled trials) Funding Unknown/not stated Setting Various (meta-analysis) Synopsis In spite of guidelines and individual studies demonstrating that early imaging does not improve outcomes in patients with low-back pain in the absence of red flags suggesting serious underlying pathology, it is still common for physicians to perform x-rays in patients without any real indication. These authors systematically searched Medline and the Cochrane Clinical Trials Register for randomized trials that compared early imaging with routine clinical care without imaging in patients with low-back pain who lacked red flags. Two reviewers independently determined whether studies should be included, assessed study quality, and extracted data. They resolved discrepancies by consensus. They identified 6 trials with approximately 1800 patients and follow-ups between 3 weeks and 2 years. Four studies compared x-rays with usual care, 1 compared MRI or CT with usual care, and in 1 study all patients had MRI but whether the results were provided was randomly assigned. In all the studies, regardless of length of follow-up, there was no difference in pain, function, disability, or quality of life. Reference
Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373(9662):463472.
Financial Incentives to Patients Improve Smoking Quit Rates Clinical Question Do f inancial incentives for patients improve their success with smoking cessation? Bottom Line It pays to quit smoking. Literally. Patients who received up to $750 in financial incentives were much more likely to be abstinent from tobacco at 9 months to 12 months than were those not receiving such an incentive (number needed to treat [NNT] = 10). (LOE = 1b) Study Design Randomized controlled trial (nonblinded) Funding Government Allocation Concealed Setting Population-based Synopsis Adults who smoked at least 5 cigarettes per day from several work sites of a large corporation were randomized to financial incentives or no financial incentives. The incentives included $100 to attend a community-based smoking cessation program, $250 to be abstinent at 3 to 6 months (confirmed by cotinine levels), and another $400 to be abstinent at 9 to 12 months. Patients in the nonincentivized group were able to attend the program but received no compensation for having quit smoking. The mean age of participants was 45 years, 65% were men, and the mean cigarettes per day was 20; they had also made an average of 6 previous attempts to quit. Of 878 randomized participants, approximately 25% in each group withdrew or were lost to follow-up during the study period. Par-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
ticipation in the smoking cessation program was greater in the incentive group (15.4% vs 5.4%; P < .001) as was confirmed abstinence at 9 months to 12 months (14.7% vs 5.0%; P < .001; NNT = 10).
Reference
Volpp KG, Troxel AB, Pauly MV, et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 2009;360(7):699-709.
Bursa Injection No Better Than Systemic Steroid for Rotator Cuff Clinical Question Is shoulder injection of a corticosteroid more effective than systemic steroid therapy in patients with rotator cuff disease? Bottom Line Subacromial bursa injection, even under ultrasound guidance, provides no better pain and movement relief than an injection of the same amount of corticosteroid (triamcinolone, 20 mg) into the upper gluteal region. Since all patients received both a gluteal and shoulder injection, there is the possibility of an additional placebo effect of an injection “where it hurts.” (LOE = 1b-) Study Design Randomized controlled trial (double-blinded) Funding Self-funded or unfunded Allocation Concealed Setting Outpatient (primary care) Synopsis To determine the effectiveness of a subacromial bursa injection of corticosteroid, these Norwegian investigators recruited 106 patients from general practices with rotator cuff pain lasting at least 3 months, VOL. 101, NO. 6, JUNE 2009 629