Chris G Maher

The University of Sydney · School of Public Health

To investigate the efficacy and safety of paracetamol (acetaminophen) in the management of spinal pain and osteoarthritis of the hip or knee. Systematic review and meta-analysis. Medline, Embase, AMED, CINAHL, Web of Science, LILACS, International Pharmaceutical Abstracts, and Cochrane Central Register of Controlled Trials from inception to Decembe...

Background Regular paracetamol is the recommended first-line analgesic for acute low-back pain; however, no high-quality evidence supports this recommendation. We aimed to assess the efficacy of paracetamol taken regularly or as-needed to improve time to recovery from pain, compared with placebo, in patients with low-back pain. Methods We did a mu...

To review the evidence on diagnostic accuracy of red flag signs and symptoms to screen for fracture or malignancy in patients presenting with low back pain to primary, secondary, or tertiary care. Systematic review. Medline, OldMedline, Embase, and CINAHL from earliest available up to 1 October 2013. Primary diagnostic studies comparing red flags f...

Existing guidelines and systematic reviews provide inconsistent recommendations on epidural corticosteroid injections for sciatica. Key limitations of existing reviews are the inclusion of trials with active controls of unknown efficacy and failure to provide an estimate of the size of the treatment effect. To determine the efficacy of epidural cor...

We aimed to investigate whether the addition of non-steroidal anti-inflammatory drugs or spinal manipulative therapy, or both, would result in faster recovery for patients with acute low back pain receiving recommended first-line care. 240 patients with acute low back pain who had seen their general practitioner and had been given advice and parace...

Background Exercise for the prevention of low back pain recurrences is recommended, but under-researched. The effectiveness and cost-effectiveness of a walking program for preventing low back pain recurrence remains unknown. This a priori statistical analysis plan describes the methods of analysis for the WalkBack trial. Methods WalkBack is a pros...

Background: Spinal cord stimulation (SCS) is a surgical intervention used to treat persistent low back pain. SCS is thought to modulate pain by sending electrical signals via implanted electrodes into the spinal cord. The long term benefits and harms of SCS for people with low back pain are uncertain. Objectives: To assess the effects, including...

Questions: Do magnetic resonance imaging (MRI) findings predict future low back pain (LBP), associated disability and global recovery in people with current LBP? Do MRI findings predict these outcomes in people with no current LBP? Do MRI findings predict these outcomes in a mixed sample of people with and without current LBP? Design: This revie...

Background Exercise for the prevention of low back pain recurrences is recommended, but under-researched. The effectiveness and cost-effectiveness of a walking program for preventing low back pain recurrence remains unknown. This a priori statistical analysis plan describes the methods of analysis for the WalkBack Trial. Methods WalkBack is a pros...

Background: The comparative benefits and harms of opioids for musculoskeletal pain in the emergency department (ED) are uncertain. Purpose: To evaluate the comparative effectiveness and harms of opioids for musculoskeletal pain in the ED setting. Data sources: Electronic databases and registries from inception to 7 February 2022. Study select...

Question: What are the effects of diagnostic labels and advice, and interactions between labels and advice, on perceived need for shoulder surgery for rotator cuff disease? Design: 2×2 factorial online randomised experiment. Participants: People with shoulder pain. Intervention: Participants read a scenario describing a patient with rotator...

Importance: Audit and feedback can improve professional practice, but few trials have evaluated its effectiveness in reducing potential overuse of musculoskeletal diagnostic imaging in general practice. Objective: To evaluate the effectiveness of audit and feedback for reducing musculoskeletal imaging by high-requesting Australian general practi...

Objectives: To provide a comprehensive overview of the efficacy, safety, and tolerability of antidepressants for pain conditions.Design: Overview of systematic reviews.Data sources: PubMed, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to June 20, 2022.Eligibility criteria: Systematic reviews comparing any...

Background Subacromial decompression surgery and rotator cuff repair surgery are often used to treat shoulder pain but evidence suggests these surgeries provide limited clinical benefit and may cause harm. We developed a patient decision aid – guided by the International Patient Decision Aids Standards (IPDAS) – that presents evidence-based informa...

Objective: Explore physiotherapists' attitudes, views, and beliefs towards the Australian Physiotherapy Association's (APA) Choosing Wisely recommendations. Design: Qualitative interview study. Methods: We conducted semi-structured interviews with physiotherapists who were registered to practise in Australia. We purposively recruited participa...

Objective To evaluate the effects of a patient decision aid for people considering shoulder surgery. Methods Participants with shoulder pain considering shoulder surgery (n=425) were recruited online and randomised to i) a decision aid outlining the benefits and harms of shoulder surgery and non-surgical options (then randomised to a side-by-side...

Background No study to our knowledge has explored physical therapy utilization following lumbar spine surgery in a workers’ compensation setting. Objectives Describe physical therapy utilization and costs, and return-to-work status in patients following lumbar spine surgery under a workers’ compensation claim. Methods Using data from the New Sout...

Background: Patients and clinicians may misinterpret the clinical importance of imaging findings in patients with low back pain, leading to potential harm related to overdiagnosis. Purpose: Our aims were to qualitatively summarize the characteristics of tested interventions that target the reporting, communication, or clinical interpretation of...

Objective: To evaluate the efficacy and safety of opioids for analgesic therapy for people with osteoarthritis. Study design: Systematic review and meta-analysis of randomised, placebo-controlled trials of opioid therapies for treating the pain of osteoarthritis. The primary outcome was medium term pain relief (six weeks to less than 12 months)....

Objective: We aimed to determine, in those who present to the ED with low back pain (LBP): (i) the prevalence of four key diagnostic categories, (ii) trends in lumbar imaging from 2015 to 2019 and (iii) the effect of a new model of care on lumbar imaging in the ED. Methods: We conducted a retrospective analysis of routinely collected medical dat...

Background Understanding barriers and enablers to monitoring and deprescribing opioids will enable the development of tailored interventions to improve both practices. Objective To perform a qualitative evidence synthesis of the barriers and enablers to monitoring ongoing appropriateness and deprescribing of opioids for chronic non-cancer pain (CN...

Introduction Long waiting time is an important barrier to accessing recommended care for low back pain (LBP) in Australia’s public health system. This study describes the protocol for a randomised controlled trial (RCT) that aims to establish the feasibility of delivering and evaluating stratified care integrated with telehealth (‘Rapid Stratified...

Objective To investigate what format for providing patient information (i.e. written summary, infographic or video animation) is most effective for promoting correct beliefs about imaging and inevitable consequences of low back pain (LBP). Design Randomised controlled trial. Setting/Patients One hundred and fifty-nine patients with non-specific L...

BACKGROUND Internet-based self-management programs and telerehabilitation initiatives have grown with the development of new technologies and have been extensively used for delivering healthcare in many areas. These programs overcome common barriers that patients face with traditional face-to-face healthcare, such as travel, lack of time, and high...

Objectives Explore how people perceive different labels for rotator cuff disease in terms of words or feelings evoked by the label and treatments they feel are needed. Setting We performed a content analysis of qualitative data collected in a six-arm, online randomised controlled experiment. Participants 1308 people with and without shoulder pain...

Background Guidelines now discourage opioid analgesics for chronic non-cancer pain because the benefits frequently do not outweigh the harms. This review determined the proportion of patients with chronic non-cancer pain who are prescribed an opioid, the types prescribed, and factors associated with prescribing. Methods Database searches were cond...

The management of patients with lumbosacral radicular pain (LRP) is of primary importance to healthcare professionals. This study aimed to: identify international clinical practice guidelines on LRP, assess their methodological quality, and summarize their diagnostic and therapeutic recommendations. A systematic search was performed (August 2019) i...

Objective : To summarise the proportion of consumer webpages on subacromial decompression and rotator cuff repair surgery that make an accurate portrayal of the evidence for these surgeries (primary outcome), mention the benefits and harms of surgery, outline alternatives to surgery, and make various surgical recommendations. Design Content analys...

Purpose: To estimate the healthcare resource utilisation of an Australian cohort of people with sciatica and explore individual-level factors associated with expenditure. Methods: Healthcare utilisation (services and medication) data from a randomised, double-blind, placebo-controlled trial of pregabalin in patients with sciatica (n = 185) were...

Objective: To investigate whether different labels for rotator cuff disease influence people's perceived need for surgery. Design: Randomized controlled experiment. Methods: Participants with and without shoulder pain read a vignette describing a patient with rotator cuff disease, and were randomized to one of six labels: subacromial impingeme...

Objective To evaluate the efficacy and safety of paracetamol as an analgesic medication in a range of painful conditions. Study design Systematic review of systematic reviews of the analgesic effects of paracetamol in randomised, placebo‐controlled trials. Conduct of systematic reviews was assessed with AMSTAR‐2; confidence in effect estimates (qu...

Background Overuse of lumbar imaging is common in the emergency department (ED). Few trials have examined interventions to address this. We evaluated the effectiveness of a multifaceted intervention to implement guideline recommendations for low back pain in the emergency department. Methods We conducted a stepped-wedge, cluster-randomised trial i...

Background Understanding how much physiotherapy people receive before lumbar spine surgery could give insight into what people and clinicians consider an adequate trial of non-operative management. The aim of this study was to investigate physiotherapy utilisation and costs before lumbar spine surgery under a workers’ compensation claim in New Sout...

Background: Community awareness of the harms of overdiagnosis remains low. Objective: To evaluate community responses to a public health campaign designed for health service waiting rooms that focuses on the harms of unnecessary diagnostic imaging for low back pain. Methods: We conducted two focus groups of 19 community members with or without...

Objective: To describe the proportion of national health surveys that contained questions on the prevalence and consequences of musculoskeletal conditions. Methods: We used a comprehensive search strategy to obtain national health surveys from the 218 countries listed by the World Bank. Two authors independently extracted information from each n...

Background CT Imaging is often requested for patients with low back pain (LBP) by their general practitioners. It is currently unknown what reasons are common for these referrals and if CT images are ordered according to guidelines in one province in Canada, which has high rates of CT imaging. The objective of this study is to categorise lumbar spi...

Objective To review studies examining the proportion of people with chronic noncancer pain who report consuming opioids and characteristics associated with their use. Design Systematic review. Methods We searched databases from inception to February 8, 2020, and conducted citation tracking. We included observational studies reporting the proporti...

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Study design: Systematic with meta-analysis OBJECTIVES.: To investigate the efficacy and safety of epidural corticosteroid injections compared with placebo injection in reducing leg pain and disability in patients with sciatica. Summary of background data: Conservative treatments, including pharmacological and non-pharmacological treatments, are...

Background Deprescribing, the process of reducing or discontinuing unnecessary or harmful medicines is an essential part of clinical practice.Objective To evaluate the efficacy of interventions designed to deprescribe opioid analgesics for pain relief in patients with chronic non-cancer pain.Methods We searched electronic databases, including clini...

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the benefits and harms of telerehabilitation for patients with OA of the knee or hip. Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Introduction Sciatica is a lower spine condition characterised by radiating leg pain below the knee. It may be accompanied by motor and sensory loss in the distribution of a spinal nerve. There are few effective treatments for sciatica. Orally administered glucocorticoids have shown some promise, however, any beneficial effects need to be confirmed...

Background: Lumbosacral radicular pain (commonly called sciatica) is a syndrome involving patients who report radiating leg pain. Epidural corticosteroid injections deliver a corticosteroid dose into the epidural space, with the aim of reducing the local inflammatory process and, consequently, relieving the symptoms of lumbosacral radicular pain....

Objective: The aim of this study was to reanalyze and reinterpret data obtained in PACE, the first large randomized controlled trial evaluating the efficacy of paracetamol in acute low back pain, to assess the inferential reproducibility of the original conclusions. Study design and setting: Mixed effects models were used to reanalyze pain inten...

International clinical practice guidelines for low back pain contain consistent recommendations including universal provision of information and advice to remain active, discouraging routine referral for imaging, and limited prescription of opioids. This systematic review describes usual care provided by first-contact physicians to patients with lo...

Background: The prevalence of musculoskeletal symptoms among sedentary workers is high. Interventions that promote occupational standing or walking have been found to reduce occupational sedentary time, but it is unclear whether these interventions ameliorate musculoskeletal symptoms in sedentary workers. Objectives: To investigate the effective...

Introduction Much testing in medicine is aimed at healthy people to facilitate the early detection of health conditions. However, there is growing evidence that early detection is a double-edged sword that may cause harm in the form of overdiagnosis. The media can be seen as a major generator of consumer demand for health services. Previous researc...

BACKGROUND Work‐related musculoskeletal disorders are a group of musculoskeletal disorders that comprise one of the most common disorders related to occupational sick leave worldwide. Musculoskeletal disorders accounted for 21% to 28% of work absenteeism days in 2017/2018 in the Netherlands, Germany and the UK. There are several interventions that...

We read with interest the article published by Arnold et al 1 examining the effect of timing of physical therapy (PT) for acute low back pain on health services utilization (HSU). Reducing overuse of imaging, opioids, injections, and surgery for low back pain is an international priority. 2 That early access to PT could replace or reduce many of th...

Background To describe the diagnoses of people who present to the emergency department (ED) with low back pain (LBP), the proportion of people with a lumbar spine condition who arrived by ambulance, received imaging, opioids and were admitted to hospital; and to explore factors associated with these four outcomes. Methods In this retrospective stu...

Purpose (1) to examine the ability of the Örebro Musculoskeletal Pain Screening Questionnaire-short version (ÖMPSQ-SF) to predict time to return to pre-injury work duties (PID) following a work-related soft tissue injury (regardless of body location); and (2) to examine the appropriateness of 50/100 as a suitable cut-off score for case identificati...

Questions: How commonly and how quickly does low back pain reoccur in a cohort of people who have recently recovered from an episode of low back pain? What are the prognostic factors for a recurrence of low back pain? Design: Prospective inception cohort study with monthly follow-up for 12 months. Participants: A total of 250 patients who had...

Background: Low back pain (LBP) affects millions of people worldwide, and misconceptions about effective treatment options for this condition are very common. Websites sponsored by organizations recognized as trustworthy by the public, such as government agencies, hospitals, universities, professional associations, health care organizations and con...

Objective: The aim of this study was to provide an overview of the recommendations regarding the diagnosis and treatment contained in current clinical practice guidelines for patients with non-specific low back pain in primary care. We also aimed to examine how recommendations have changed since our last overview in 2010. Method: The searches fo...

Background The prognosis of acute low back pain (LBP) is typically good; however, there is substantial variation in individual patient's outcomes. We recently developed a prediction model that was able to predict the likelihood of pain recovery in patients with acute LBP who continue to have pain approximately 1‐week after initially seeking care. T...

Objectives: To compare the responsiveness of disability measures with physical activity measures in patients with chronic low back pain (CLBP) undergoing a course of physical therapy treatment. Design: This is a prospective cohort study with two-month follow-up. Subjects: A total of 106 patients presenting with non-specific CLBP of more than t...

Background: The use of anticonvulsants (e.g., gabapentin, pregabalin) to treat low back pain has increased substantially in recent years despite limited supporting evidence. We aimed to determine the efficacy and tolerability of anticonvulsants in the treatment of low back pain and lumbar radicular pain compared with placebo. Methods: A search w...

Combining medicines may give greater pain relief and/or improved tolerability. We conducted a systematic review to investigate the effects of combination drug therapy in patients with low back pain and/or sciatica on pain, disability, and adverse events. Databases and trial registers were searched from inception to July 27, 2017, for randomized tri...

Background: The Lumbar Spine Instability Questionnaire (LSIQ) is a self-report measure of 15 items. Previous studies have used the LSIQ as a measure of clinical instability; however, a comprehensive evaluation of its clinimetric properties has not been conducted. Objectives: The aim of this study was to evaluate the clinimetric properties of the...

Question: What is the effectiveness of interventions that aim to prevent a new episode of neck pain? Design: Systematic review and meta-analysis of randomised, controlled trials. Participants: People without neck pain at study entry. Intervention: Any intervention aiming to prevent a future episode of neck pain. Outcome measures: New episo...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To answer the clinical question: 'what analgesic medicine shall I prescribe this patient with chronic low back pain to reduce their pain?'. The objectives are to determine the analgesic effects, safety, effect on function, and relative rank according to analgesi...