Impact of clinical trial findings on Bell's palsy management in general practice in the UK 2001–2012: interrupted time series regression analysis

Abstract

ObjectivesTo measure the incidence of Bell's palsy and determine the impact of clinical trial findings on Bell's palsy management in the UK.DesignInterrupted time series regression analysis and incidence measures.SettingGeneral practices in the UK contributing to the Clinical Practice Research Datalink (CPRD).ParticipantsPatients ≥16 years with a diagnosis of Bell's palsy between 2001 and 2012.Interventions(1) Publication of the 2004 Cochrane reviews of clinical trials on corticosteroids and antivirals for Bell's palsy, which made no clear recommendation on their use and (2) publication of the 2007 Scottish Bell's Palsy Study (SBPS), which made a clear recommendation that treatment with prednisolone alone improves chances for complete recovery.Main outcome measuresIncidence of Bell's palsy per 100 000 person-years. Changes in the management of Bell's palsy with either prednisolone therapy, antiviral therapy, combination therapy (prednisolone with antiviral therapy) or untreated cases.ResultsDuring the 12-year period, 14 460 cases of Bell's palsy were identified with an overall incidence of 37.7/100 000 person-years. The 2004 Cochrane reviews were associated with immediate falls in prednisolone therapy (−6.3% (−11.0 to −1.6)), rising trends in combination therapy (1.1% per quarter (0.5 to 1.7)) and falling trends for untreated cases (−0.8% per quarter (−1.4 to −0.3)). SBPS was associated with immediate increases in prednisolone therapy (5.1% (0.9 to 9.3)) and rising trends in prednisolone therapy (0.7% per quarter (0.4 to 1.2)); falling trends in combination therapy (−1.7% per quarter (−2.2 to −1.3)); and rising trends for untreated cases (1.2% per quarter (0.8 to 1.6)). Despite improvements, 44% still remain untreated.ConclusionsSBPS was clearly associated with change in management, but a significant proportion of patients failed to receive effective treatment, which cannot be fully explained. Clarity and uncertainty in clinical trial recommendations may change clinical practice. However, better ways are needed to understand and circumvent barriers in implementing clinical trial findings.

Addressing the evidence to practice gap for complex interventions in primary care: a systematic review of reviews protocol

“…For example, interventions recommended as core treatment (particularly exercise, weight loss and the provision of written information) for knee pain among older adults were underused 3. Despite clinical trial findings showing a clear impact on primary care management of Bell's Palsy, a significant proportion of patients did not receive effective treatment (ie, corticosteroids) 4. Conversely, many interventions that have been proven to be ineffective continue to be used, for example, antibiotics for acute respiratory tract infection 5.…”

Optimising treatment of Bell’s Palsy in primary care: the need for early appropriate referral

“…A recent UK-wide study of management and referral practices revealed that, in 2012, 44% of all Bell's palsy diagnoses were untreated, while only 6.6% were referred to secondary care, usually otolaryngology, ophthalmology, or neurology. 12 Fewer patients were actually referred in 2012 than in 2001. Clearly, large numbers of patients are not being treated effectively in the acute setting and most patients with incomplete symptom resolution are not referred on to secondary services.…”

Får pasienter med Bells parese riktig behandling?

“…Studien viste at det var en økning i forskrivelse av prednisolon til pasienter med Bells parese etter 2007, men at 44 % av pasientene fortsatt ikke fikk noen form for behandling i 2012 (1). Noen av disse pasientene hadde trolig andre sykdommer som gjorde at prednisolon ikke ble gitt.…”

“…30 -40 per 100 000 innbyggere (1), noe som tilsvarer 1 500 -2 000 pasienter per år i Norge. Sykdommen forekommer i alle aldersgrupper, men insidensen øker med alderen (1). Omtrent 70 % av pasientene får normal nervefunksjon i løpet av seks måneder uten noen form for behandling, mens de resterende 30 % får sekvele med permanent svakhet av ansiktsmuskulaturen, muskelkontraktur og/eller synkinesier (2).…”