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General practitioners’ advice to use topical rather than oral ibuprofen resulted in equivalent effects on chronic knee pain

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M Underwood

Professor M Underwood, University of Warwick, Coventry, UK; [email protected]

QUESTION

For older patients with chronic knee pain, should general practitioners advise use of topical or oral non-steroidal anti-inflammatory drugs (NSAIDs)?

METHODS

Design:

randomised controlled trial (Topical or Oral Ibuprofen [TOIB]).

Allocation:

concealed.

Blinding:

blinded (data collectors).

Follow-up period:

12 months.

Setting:

26 general practices in the UK.

Patients:

282 patients ⩾50 years of age (mean age 63 y, 54% women) with knee pain (97% with osteoarthritis). Exclusion criteria included history of, or awaiting, knee replacement, and recent knee injury.

Intervention:

the patient’s general practitioner recommended preferential use of topical ibuprofen (n = 138) or oral ibuprofen (n = 144).

Outcomes:

Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, adverse effects, and cost-effectiveness. The study had >80% power to show equivalence in WOMAC scores to within 10 mm (α = 0.05).

Patient follow-up:

88% (intention-to-treat …

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