ABSTRACT
<p><b>BACKGROUND</b>Musculoskeletal disorders (MSD) comprise a wide range of conditions, associated with an enormous pain and impaired mobility, and are affecting people's lives and work. Management of musculoskeletal disorders typically involves a multidisciplinary team approach. Positive findings have been found in previous studies evaluating the effectiveness of complementary therapies, though little attention has been paid to evaluating of the effectiveness of integrated packages of care combining conventional and complementary approaches for musculoskeletal conditions in a National Health Service (NHS) setting.</p><p><b>OBJECTIVE</b>To determine the feasibility of all aspects of a pragmatic observational study designed: (1) to evaluate the effectiveness and cost effectiveness of integrated treatments for MSDs in an integrated NHS hospital in the UK; (2) to determine the acceptability of the study design and research process to patients; (3) to explore patients' expectation and experience of receiving integrated treatments.</p><p><b>METHODS</b>This is an observational feasibility study, with 1-year recruitment and 1-year follow-up, conducted in Royal London Hospital for Integrated Medicine, University College London Hospital Trust, UK. All eligible patients with MSDs newly referred to the hospital were included in the study. Interventions are integrated packages of care (conventional and complementary) as currently provided in the hospital. SF-36™ Health Survey, short form Brief Pain Inventory, Visual Analogue Scale, and modified Client Service Receipt Inventory will be assessed at 4/5 time points. Semi-structured interview/focus group will be carried out before treatment, and 1 year after commence of treatment.</p><p><b>DISCUSSION</b>We intend to conduct a pragmatic observational study of integrated medical treatment of MSDs at a public sector hospital. It will inform the design of a future trial including recruitment, retention, suitability of the outcome measures and patients experiences.</p>
Subject(s)
Humans , Data Collection , Feasibility Studies , Musculoskeletal Diseases , Therapeutics , Outcome Assessment, Health Care , Statistics as TopicABSTRACT
Temporary feeding on willow buds and leaves by nesting greater snow geese provided us with an opportunity to test the relative importance of nutrients and deterrents in affecting the palatability for geese of a food plant with a high phenol content. Protein, total phenol and fiber (neutral and acid detergent fiber, and lignin) were analyzed in closed and open buds and in rolled and open leaves. Geese feed on willows at the open-buds and rolled-leaf stages but not at the closed-bud and open-leaf stages. Protein content was higher in open buds and rolled leaves (25-27%) than in closed buds and open leaves (19-21%). Phenol content increased during leaf emergence but was already high (14%) in rolled leaves. All plant fibers were very high in closed buds but declined rapidly during leaf emergence. The increase in phenol: protein ratio appeared to be more important than phenol concentration alone in explaining the cessation of feeding by geese on willow leaves whereas the high fiber content of closed buds may explain why they were not eaten. Our results illustrate the value of a multifactorial approach in the study of the food selection process in herbivores.
