{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:16:38Z","timestamp":1779167798398,"version":"3.51.4"},"reference-count":121,"publisher":"National Institute for Health and Care Research","issue":"75","license":[{"start":{"date-parts":[[2016,10,1]],"date-time":"2016-10-01T00:00:00Z","timestamp":1475280000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["07\/37\/61"],"award-info":[{"award-number":["07\/37\/61"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001702","name":"AO Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001702","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"<jats:sec id=\"abs1-1\"><jats:title>Background<\/jats:title><jats:p>Close contact casting (CCC) may offer an alternative to open reduction and internal fixation (ORIF) surgery for unstable ankle fractures in older adults.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-2\"><jats:title>Objectives<\/jats:title><jats:p>We aimed to (1) determine if CCC for unstable ankle fractures in adults aged over 60 years resulted in equivalent clinical outcome compared with ORIF, (2) estimate cost-effectiveness to the NHS and society and (3) explore participant experiences.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-3\"><jats:title>Design<\/jats:title><jats:p>A pragmatic, multicentre, equivalence randomised controlled trial incorporating health economic evaluation and qualitative study.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-4\"><jats:title>Setting<\/jats:title><jats:p>Trauma and orthopaedic departments of 24 NHS hospitals.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-5\"><jats:title>Participants<\/jats:title><jats:p>Adults aged over 60 years with unstable ankle fracture. Those with serious limb or concomitant disease or substantial cognitive impairment were excluded.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-6\"><jats:title>Interventions<\/jats:title><jats:p>CCC was conducted under anaesthetic in theatre by surgeons who attended training. ORIF was as per local practice. Participants were randomised in 1\u2009:\u20091 allocation via remote telephone randomisation. Sequence generation was by random block size, with stratification by centre and fracture pattern.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-7\"><jats:title>Main outcome measures<\/jats:title><jats:p>Follow-up was conducted at 6 weeks and, by blinded outcome assessors, at 6 months after randomisation. The primary outcome was the Olerud\u2013Molander Ankle Score (OMAS), a patient-reported assessment of ankle function, at 6 months. Secondary outcomes were quality of life (as measured by the European Quality of Life 5-Dimensions, Short Form questionnaire-12 items), pain, ankle range of motion and mobility (as measured by the timed up and go test), patient satisfaction and radiological measures. In accordance with equivalence trial US Food and Drug Administration guidance, primary analysis was per protocol.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-8\"><jats:title>Results<\/jats:title><jats:p>We recruited 620 participants, 95 from the pilot and 525 from the multicentre phase, between June 2010 and November 2013. The majority of participants, 579 out of 620 (93%), received the allocated treatment; 52 out of 275 (19%) who received CCC later converted to ORIF because of loss of fracture reduction. CCC resulted in equivalent ankle function compared with ORIF at 6 months {OMAS 64.5 points [standard deviation (SD) 22.4 points] vs. OMAS 66.0 points (SD 21.1 points); mean difference \u20130.65 points, 95% confidence interval (CI) \u20133.98 to 2.68 points; standardised effect size \u20130.04, 95% CI \u20130.23 to 0.15}. There were no differences in quality of life, ankle motion, pain, mobility and patient satisfaction. Infection and\/or wound problems were more common with ORIF [29\/298 (10%) vs. 4\/275 (1%)], as were additional operating theatre procedures [17\/298 (6%) vs. 3\/275 (1%)]. Malunion was more common with CCC [38\/249 (15%) vs. 8\/274 (3%);<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001]. Malleolar non-union was lower in the ORIF group [lateral: 0\/274 (0%) vs. 8\/248 (3%);<jats:italic>p<\/jats:italic>\u2009=\u20090.002; medial: 3\/274 (1%) vs. 18\/248 (7%);<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001]. During the trial, CCC showed modest mean cost savings [NHS mean difference \u2013\u00a3644 (95% CI \u2013\u00a31390 to \u00a376); society mean difference \u2013\u00a3683 (95% CI \u2013\u00a31851 to \u00a3536)]. Estimates showed some imprecision. Incremental quality-adjusted life-years following CCC were no different from ORIF. Over common willingness-to-pay thresholds, the probability that CCC was cost-effective was very high (&gt;\u200995% from NHS perspective and 85% from societal perspective). Experiences of treatments were similar; both groups endured the impact of fracture, uncertainty regarding future function and the need for further interventions.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-9\"><jats:title>Limitations<\/jats:title><jats:p>Assessors at 6 weeks were necessarily not blinded. The learning-effect analysis was inconclusive because of limited CCC applications per surgeon.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-10\"><jats:title>Conclusions<\/jats:title><jats:p>CCC provides a clinically equivalent outcome to ORIF at reduced cost to the NHS and to society at 6 months.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-11\"><jats:title>Future work<\/jats:title><jats:p>Longer-term follow-up of trial participants is under way to address concerns over potential later complications or additional procedures and their potential to impact on ankle function. Further study of the patient factors, radiological fracture patterns and outcomes, treatment responses and prognosis would also contribute to understanding the treatment pathway.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-12\"><jats:title>Trial registration<\/jats:title><jats:p>Current Controlled Trials ISRCTN04180738.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-13\"><jats:title>Funding<\/jats:title><jats:p>The National Institute for Health Research Health Technology Assessment programme and will be published in full in<jats:italic>Health Technology Assessment<\/jats:italic>; Vol. 20, No. 75. See the NIHR Journals Library website for further project information. This report was developed in association with the National Institute for Health Research Oxford Biomedical Research Unit funding scheme. The pilot phase was funded by the AO Research Foundation.<\/jats:p><\/jats:sec>","DOI":"10.3310\/hta20750","type":"journal-article","created":{"date-parts":[[2016,10,13]],"date-time":"2016-10-13T12:54:03Z","timestamp":1476363243000},"page":"1-158","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":87,"title":["The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years"],"prefix":"10.3310","volume":"20","clinical-trial-number":[{"clinical-trial-number":"isrctn04180738","registry":"10.18810\/isrctn","type":"results"}],"author":[{"given":"David J","family":"Keene","sequence":"first","affiliation":[{"name":"Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dipesh","family":"Mistry","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Nam","sequence":"additional","affiliation":[{"name":"Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Tutton","sequence":"additional","affiliation":[{"name":"Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"},{"name":"Royal College of Nursing Research Institute, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Handley","sequence":"additional","affiliation":[{"name":"Oxford Trauma Service, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lesley","family":"Morgan","sequence":"additional","affiliation":[{"name":"Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Roberts","sequence":"additional","affiliation":[{"name":"Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bridget","family":"Gray","sequence":"additional","affiliation":[{"name":"Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Briggs","sequence":"additional","affiliation":[{"name":"Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranjit","family":"Lall","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim JS","family":"Chesser","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Pallister","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah E","family":"Lamb","sequence":"additional","affiliation":[{"name":"Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"},{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"Willett","sequence":"additional","affiliation":[{"name":"Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6221","published-online":{"date-parts":[[2016,10]]},"reference":[{"key":"key2016101214380664_ref1-bib1","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: a review","volume":"37","author":"Court-Brown","year":"2006","journal-title":"Injury"},{"key":"key2016101214380664_ref1-bib2","doi-asserted-by":"publisher","first-page":"525","DOI":"10.3109\/17453674.2014.908340","article-title":"Incidence of fractures requiring inpatient care","volume":"85","author":"Somersalo","year":"2014","journal-title":"Acta Orthop"},{"key":"key2016101214380664_ref1-bib3","doi-asserted-by":"publisher","first-page":"43","DOI":"10.3109\/17453679809002355","article-title":"Adult ankle fractures \u2013 an increasing problem?","volume":"69","author":"Court-Brown","year":"1998","journal-title":"Acta Orthop"},{"key":"key2016101214380664_ref1-bib4","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1016\/S8756-3282(02)00832-3","article-title":"Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970\u20132000 and projections for the future","volume":"31","author":"Kannus","year":"2002","journal-title":"Bone"},{"key":"key2016101214380664_ref1-bib5","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/S0004-9514(09)70058-3","article-title":"Pain and dorsiflexion range of motion predict short- and medium-term activity limitation in people receiving physiotherapy intervention after ankle fracture: an observational study","volume":"55","author":"Lin","year":"2009","journal-title":"Aust J Physiother"},{"key":"key2016101214380664_ref1-bib6","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1249\/01.MSS.0000142407.25188.05","article-title":"Muscle adaptations with immobilization and rehabilitation after ankle fracture","volume":"36","author":"Stevens","year":"2004","journal-title":"Med Sci Sports Exerc"},{"key":"key2016101214380664_ref1-bib7","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1002\/jmri.22864","article-title":"A longitudinal MRI study of muscle atrophy during lower leg immobilization following ankle fracture","volume":"35","author":"Psatha","year":"2012","journal-title":"J Magn Reson Imaging"},{"key":"key2016101214380664_ref1-bib8","doi-asserted-by":"publisher","first-page":"786","DOI":"10.2519\/jospt.2005.35.12.786","article-title":"Prediction of outcome after ankle fracture","volume":"35","author":"Hancock","year":"2005","journal-title":"J Orthop Sports Phys Ther"},{"key":"key2016101214380664_ref1-bib9","doi-asserted-by":"publisher","first-page":"841","DOI":"10.2519\/jospt.2014.5199","article-title":"Prognosis of physical function following ankle fracture: a systematic review with meta-analysis","volume":"44","author":"Beckenkamp","year":"2014","journal-title":"J Orthop Sports Phys Ther"},{"key":"key2016101214380664_ref1-bib10","doi-asserted-by":"publisher","first-page":"728","DOI":"10.3113\/FAI.2009.0728","article-title":"Functional outcome after operatively treated ankle fractures in the elderly","volume":"30","author":"Davidovitch","year":"2009","journal-title":"Foot Ankle Int"},{"key":"key2016101214380664_ref1-bib11","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1186\/1471-2474-15-128","article-title":"Health care consumption and costs due to foot and ankle injuries in the Netherlands, 1986\u20132010","volume":"15","author":"De Boer","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"key":"key2016101214380664_ref1-bib12","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1186\/1471-2474-13-224","article-title":"Life impact of ankle fractures: qualitative analysis of patient and clinician experiences","volume":"13","author":"McPhail","year":"2012","journal-title":"BMC Musculoskelet Disord"},{"key":"key2016101214380664_ref1-bib13","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1016\/j.injury.2013.02.018","article-title":"Health status, health-related quality of life, and quality of life following ankle fractures: a systematic review","volume":"44","author":"Van Son","year":"2013","journal-title":"Injury"},{"key":"key2016101214380664_ref1-bib14","volume-title":"Oxford Textbook of Trauma and Orthopaedics","author":"Handley","year":"2011","edition":"2nd edn."},{"key":"key2016101214380664_ref1-bib15","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.2106\/00004623-200207000-00026","article-title":"Articular fractures: does an anatomic reduction really change the result?","volume":"84","author":"Marsh","year":"2002","journal-title":"J Bone Joint Surg Am"},{"key":"key2016101214380664_ref1-bib16","doi-asserted-by":"publisher","first-page":"416","DOI":"10.5435\/00124635-200411000-00006","article-title":"Articular fractures","volume":"12","author":"Dirschl","year":"2004","journal-title":"J Am Acad Orthop Surg"},{"key":"key2016101214380664_ref1-bib17","doi-asserted-by":"crossref","first-page":"356","DOI":"10.2106\/00004623-197658030-00010","article-title":"Changes in tibiotalar area of contact caused by lateral talar shift","volume":"58","author":"Ramsey","year":"1976","journal-title":"J Bone Joint Surg Am"},{"key":"key2016101214380664_ref1-bib18","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1097\/01.bot.0000211150.00919.0e","article-title":"Incongruity-dependent changes of contact stress rates in human cadaveric ankles","volume":"20","author":"McKinley","year":"2006","journal-title":"J Orthop Trauma"},{"key":"key2016101214380664_ref1-bib19","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1097\/01.bot.0000246468.80635.ef","article-title":"Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease","volume":"20","author":"Brown","year":"2006","journal-title":"J Orthop Trauma"},{"key":"key2016101214380664_ref1-bib20","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1097\/BOT.0b013e31818915d9","article-title":"Posttraumatic ankle osteoarthritis after ankle-related fractures","volume":"23","author":"Horisberger","year":"2009","journal-title":"J Orthop Trauma"},{"key":"key2016101214380664_ref1-bib21","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1097\/01.bot.0000211160.05864.14","article-title":"The development of posttraumatic arthritis after articular fracture","volume":"20","author":"Furman","year":"2006","journal-title":"J Orthop Trauma"},{"key":"key2016101214380664_ref1-bib22","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.injury.2010.04.006","article-title":"Long-term outcome after 1822 operatively treated ankle fractures: a systematic review of the literature","volume":"42","author":"Stufkens","year":"2011","journal-title":"Injury"},{"key":"key2016101214380664_ref1-bib23","doi-asserted-by":"publisher","first-page":"CD008470","DOI":"10.1002\/14651858.cd008470.pub2","article-title":"Surgical versus conservative interventions for treating ankle fractures in adults","volume":"8","author":"Donken","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"key2016101214380664_ref1-bib24","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1016\/j.injury.2013.11.008","article-title":"Early complications of surgery in operative treatment of ankle fractures in those over 60: a review of 186 cases","volume":"45","author":"Zaghloul","year":"2014","journal-title":"Injury"},{"key":"key2016101214380664_ref1-bib25","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/0020-1383(87)90189-6","article-title":"The treatment of unstable fractures of the ankle in the elderly","volume":"18","author":"Litchfield","year":"1987","journal-title":"Injury"},{"key":"key2016101214380664_ref1-bib26","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1097\/00005131-199308000-00015","article-title":"Biomechanical testing of a new design for Schanz pedicle screws","volume":"7","author":"Willett","year":"1993","journal-title":"J Orthop Trauma"},{"key":"key2016101214380664_ref1-bib27","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.2106\/JBJS.H.00653","article-title":"Complication rates following open reduction and internal fixation of ankle fractures","volume":"91","author":"SooHoo","year":"2009","journal-title":"J Bone Joint Surg Am"},{"key":"key2016101214380664_ref1-bib28","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1097\/00003086-198510000-00004","article-title":"Malleolar fractures: nonoperative versus operative treatment. A controlled study","volume":"199","author":"Bauer","year":"1985","journal-title":"Clin Orthop Relat Res"},{"key":"key2016101214380664_ref1-bib29","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1302\/0301-620X.83B4.11522","article-title":"Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomised study","volume":"83","author":"Makwana","year":"2001","journal-title":"J Bone Joint Surg Br"},{"key":"key2016101214380664_ref1-bib30","doi-asserted-by":"crossref","first-page":"67","DOI":"10.2106\/00004623-198567010-00010","article-title":"A prospective, randomized study of the management of severe ankle fractures","volume":"67","author":"Phillips","year":"1985","journal-title":"J Bone Joint Surg Am"},{"key":"key2016101214380664_ref1-bib31","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1302\/0301-620X.68B4.3090049","article-title":"A prospective trial comparing operative and manipulative treatment of ankle fractures","volume":"68","author":"Rowley","year":"1986","journal-title":"J Bone Joint Surg Br"},{"key":"key2016101214380664_ref1-bib32","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.2337\/diacare.24.6.1019","article-title":"Off-loading the diabetic foot wound: a randomized clinical trial","volume":"24","author":"Armstrong","year":"2001","journal-title":"Diabetes Care"},{"key":"key2016101214380664_ref1-bib33","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1177\/107110070402500808","article-title":"Safety of total contact casting in high-risk patients with neuropathic foot ulcers","volume":"25","author":"Wukich","year":"2004","journal-title":"Foot Ankle Int"},{"key":"key2016101214380664_ref1-bib34","doi-asserted-by":"publisher","first-page":"243","DOI":"10.2337\/diacare.28.2.243","article-title":"Total contact casting of the diabetic foot in daily practice: a prospective follow-up study","volume":"28","author":"Nabuurs-Franssen","year":"2005","journal-title":"Diabetes Care"},{"key":"key2016101214380664_ref1-bib35","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.injury.2009.06.170","article-title":"The presence and pattern of vascular insufficiency in the older patient suffering an unstable ankle fracture: the relationship to skin and wound complications","volume":"40","author":"Willett","year":"2009","journal-title":"Injury Extra"},{"key":"key2016101214380664_ref1-bib36","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1016\/S0140-6736(09)61116-8","article-title":"No surgical innovation without evaluation: the IDEAL recommendations","volume":"374","author":"McCulloch","year":"2009","journal-title":"Lancet"},{"key":"key2016101214380664_ref1-bib37","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1016\/j.injury.2010.03.026","article-title":"Orthopaedic trauma research priority-setting exercise and development of a research network","volume":"41","author":"Willett","year":"2010","journal-title":"Injury"},{"key":"key2016101214380664_ref1-bib38","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1186\/1471-2474-15-79","article-title":"Ankle Injury Management (AIM): design of a pragmatic multi-centre equivalence randomised controlled trial comparing Close Contact Casting (CCC) to Open surgical Reduction and Internal Fixation (ORIF) in the treatment of unstable ankle fractures in patients over 60 years","volume":"15","author":"Willett","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"key":"key2016101214380664_ref1-bib39","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u2018Mini-mental state\u2019. A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J Psychiatr Res"},{"key":"key2016101214380664_ref1-bib40","volume-title":"AO Principles of Fracture Management","author":"Ruedi","year":"2000"},{"key":"key2016101214380664_ref1-bib41","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1007\/BF00435553","article-title":"A scoring scale for symptom evaluation after ankle fracture","volume":"103","author":"Olerud","year":"1984","journal-title":"Arch Orthop Trauma Surg"},{"key":"key2016101214380664_ref1-bib42","doi-asserted-by":"publisher","first-page":"337","DOI":"10.3109\/07853890109002087","article-title":"EQ-5D: a measure of health status from the EuroQol Group","volume":"33","author":"Rabin","year":"2001","journal-title":"Ann Med"},{"key":"key2016101214380664_ref1-bib43","doi-asserted-by":"publisher","first-page":"1171","DOI":"10.1016\/S0895-4356(98)00109-7","article-title":"Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment","volume":"51","author":"Gandek","year":"1998","journal-title":"J Clin Epidemiol"},{"key":"key2016101214380664_ref1-bib44","volume-title":"Joint Range of Motion and Muscle Length Testing","author":"Reese","year":"2002"},{"key":"key2016101214380664_ref1-bib45","volume-title":"Musculoskeletal Assessment: Joint Range of Motion and Manual Muscle Strength","author":"Clarkson","year":"2000","edition":"2nd edn."},{"key":"key2016101214380664_ref1-bib46","first-page":"387","article-title":"Balance in elderly patients: the \u2018get-up and go\u2019 test","volume":"67","author":"Mathias","year":"1986","journal-title":"Arch Phys Med Rehabil"},{"key":"key2016101214380664_ref1-bib47","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1056\/NEJM199503023320902","article-title":"Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability","volume":"332","author":"Guralnik","year":"1995","journal-title":"N Engl J Med"},{"key":"key2016101214380664_ref1-bib48","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1097\/00005131-199209000-00014","article-title":"Postoperative radiographs as predictors of clinical outcome in unstable ankle fractures","volume":"6","author":"Mont","year":"1992","journal-title":"J Orthop Trauma"},{"key":"key2016101214380664_ref1-bib49","volume-title":"Sample Size Tables For Clinical Studies","author":"Machin","year":"1997","edition":"2nd edn."},{"key":"key2016101214380664_ref1-bib50","volume-title":"Clinical Trials: A Practical Approach","author":"Pocock","year":"1983"},{"key":"key2016101214380664_ref1-bib51","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1023\/A:1011503032353","article-title":"On sample size calculation in bioequivalence trials","volume":"28","author":"Chow","year":"2001","journal-title":"J Pharmacokinet Pharmacodyn"},{"key":"key2016101214380664_ref1-bib52","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1016\/j.jhep.2007.02.015","article-title":"Methodology of superiority vs. equivalence trials and non-inferiority trials","volume":"46","author":"Christensen","year":"2007","journal-title":"J Hepatol"},{"key":"key2016101214380664_ref1-bib53","doi-asserted-by":"publisher","first-page":"1152","DOI":"10.1001\/jama.295.10.1152","article-title":"Reporting of noninferiority and equivalence randomized trials: an extension of the CONSORT statement","volume":"295","author":"Piaggio","year":"2006","journal-title":"JAMA"},{"key":"key2016101214380664_ref1-bib54","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1002\/(SICI)1097-0258(19960715)15:13<1421::AID-SIM266>3.0.CO;2-H","article-title":"An index for assessing blindness in a multi-centre clinical trial: disulfiram for alcohol cessation \u2013 a VA cooperative study","volume":"15","author":"James","year":"1996","journal-title":"Stat Med"},{"key":"key2016101214380664_ref1-bib55","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1097\/00005650-199711000-00002","article-title":"Modeling valuations for EuroQol health states","volume":"35","author":"Dolan","year":"1997","journal-title":"Med Care"},{"key":"key2016101214380664_ref1-bib56","volume-title":"Hip Fracture: The Management of Hip Fracture in Adults","author":"National Institute for Health and Care Excellence (NICE)","year":"2011"},{"key":"key2016101214380664_ref1-bib57","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1111\/j.1365-2044.2010.06382.x","volume":"65","author":"Chakladar","year":"2010","journal-title":"Anaesthesia"},{"key":"key2016101214380664_ref1-bib58","volume-title":"Theatre \u2013 Direct Cost Per Hour, by Specialty [R142X]","author":"Information Services Division Scotland","year":"2012"},{"key":"key2016101214380664_ref1-bib59","volume-title":"NHS Reference Costs 2011\u20132012","author":"Department of Health","year":"2012"},{"key":"key2016101214380664_ref1-bib60","volume-title":"Community Bed Review","author":"NHS West Sussex","year":"2011"},{"key":"key2016101214380664_ref1-bib61","volume-title":"Unit Costs of Health and Social Care 2012","author":"Curtis","year":"2012"},{"key":"key2016101214380664_ref1-bib62","volume-title":"Department of Health: Transforming NHS Ambulance Services","author":"National Audit Office (NAO)","year":"2011"},{"key":"key2016101214380664_ref1-bib63","volume-title":"British National Formulary","author":"Joint Formulary Committee"},{"key":"key2016101214380664_ref1-bib64","volume-title":"Employment Rates and Average Hourly Wage for 1994 to 2012","author":"Office for National Statistics","year":"2012"},{"key":"key2016101214380664_ref1-bib65","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1002\/(SICI)1097-0258(19990330)18:6<681::AID-SIM71>3.0.CO;2-R","article-title":"Multiple imputation of missing blood pressure covariates in survival analysis","volume":"18","author":"Van Buuren","year":"1999","journal-title":"Stat Med"},{"key":"key2016101214380664_ref1-bib66","doi-asserted-by":"publisher","first-page":"1249","DOI":"10.3113\/FAI.2007.1249","article-title":"Complications after ankle fracture in elderly patients","volume":"28","author":"Koval","year":"2007","journal-title":"Foot Ankle Int"},{"key":"key2016101214380664_ref1-bib67","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1097\/00005131-200105000-00006","article-title":"Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures","volume":"15","author":"Brown","year":"2001","journal-title":"J Orthop Trauma"},{"key":"key2016101214380664_ref1-bib68","volume-title":"Medical Research Council: Guidelines for Good Clinical Practice in Clinical Trials","author":"Medical Research Council","year":"1998"},{"key":"key2016101214380664_ref1-bib69","doi-asserted-by":"publisher","first-page":"c332","DOI":"10.1136\/bmj.c332","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials","volume":"340","author":"Schulz","year":"2010","journal-title":"BMJ"},{"key":"key2016101214380664_ref1-bib70","doi-asserted-by":"publisher","first-page":"295","DOI":"10.7326\/0003-4819-148-4-200802190-00008","article-title":"Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration","volume":"148","author":"Boutron","year":"2008","journal-title":"Ann Intern Med"},{"key":"key2016101214380664_ref1-bib71","doi-asserted-by":"publisher","first-page":"a2390","DOI":"10.1136\/bmj.a2390","article-title":"Improving the reporting of pragmatic trials: an extension of the CONSORT statement","volume":"337","author":"Zwarenstein","year":"2008","journal-title":"BMJ"},{"key":"key2016101214380664_ref1-bib72","doi-asserted-by":"crossref","first-page":"g1687","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide","volume":"348","author":"Hoffmann","year":"2014","journal-title":"BMJ"},{"key":"key2016101214380664_ref1-bib73","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v045.i03","article-title":"MICE: multivariate imputation by chained equations in R","volume":"45","author":"Buuren","year":"2011","journal-title":"J Stat Softw"},{"key":"key2016101214380664_ref1-bib74","doi-asserted-by":"publisher","first-page":"1800","DOI":"10.1007\/s11999-008-0543-6","article-title":"Etiology of ankle osteoarthritis","volume":"467","author":"Valderrabano","year":"2009","journal-title":"Clin Orthop Relat Res"},{"key":"key2016101214380664_ref1-bib75","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1016\/j.injury.2010.08.003","article-title":"Articular step-off and risk of post-traumatic osteoarthritis. Evidence today","volume":"41","author":"Giannoudis","year":"2010","journal-title":"Injury"},{"key":"key2016101214380664_ref1-bib76","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1097\/BOT.0b013e31824aec42","article-title":"Is surgical fixation for stress-positive unstable ankle fractures cost effective? Results of a multicenter randomized control trial","volume":"26","author":"Slobogean","year":"2012","journal-title":"J Orthop Trauma"},{"key":"key2016101214380664_ref1-bib77","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1097\/BOT.0b013e31828f9a88","article-title":"Using decision analysis to assess comparative clinical efficacy of surgical treatment of unstable ankle fractures","volume":"27","author":"Michelson","year":"2013","journal-title":"J Orthop Trauma"},{"key":"key2016101214380664_ref1-bib78","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1097\/BOT.0b013e3182460837","article-title":"Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial","volume":"26","author":"Sanders","year":"2012","journal-title":"J Orthop Trauma"},{"key":"key2016101214380664_ref1-bib79","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1302\/0301-620X.92B1.22540","article-title":"Treatment of malunited fractures of the ankle: a long-term follow-up of reconstructive surgery","volume":"92","author":"Reidsma","year":"2010","journal-title":"J Bone Joint Surg Br"},{"key":"key2016101214380664_ref1-bib80","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1111\/j.1365-2648.2004.03068.x","article-title":"What counts as evidence in evidence-based practice?","volume":"47","author":"Rycroft-Malone","year":"2004","journal-title":"J Adv Nurs"},{"key":"key2016101214380664_ref1-bib81","doi-asserted-by":"publisher","first-page":"2525","DOI":"10.1111\/j.1365-2648.2011.05707.x","article-title":"Older people\u2019s views in relation to risk of falling and need for intervention: a meta-ethnography","volume":"67","author":"McInnes","year":"2011","journal-title":"J Adv Nurs"},{"key":"key2016101214380664_ref1-bib82","volume-title":"Developing and Implementing NICE Guidance on Patient Experience","author":"Staniszewska","year":"2012"},{"key":"key2016101214380664_ref1-bib83","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.injury.2011.01.021","article-title":"What can qualitative approaches bring to trauma outcome research?","volume":"42","author":"Gooberman-Hill","year":"2011","journal-title":"Injury"},{"key":"key2016101214380664_ref1-bib84","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1177\/1740774510392257","article-title":"Personal benefit, or benefiting others? Deciding whether to take part in clinical trials","volume":"8","author":"Locock","year":"2011","journal-title":"Clin Trials"},{"key":"key2016101214380664_ref1-bib85","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/1745-6215-7-32","article-title":"Duty, desire or indifference? A qualitative study of patient decisions about recruitment to an epilepsy treatment trial","volume":"7","author":"Canvin","year":"2006","journal-title":"Trials"},{"issue":"8","key":"key2016101214380664_ref1-bib86","doi-asserted-by":"publisher","DOI":"10.3310\/hta9080","article-title":"Lay public\u2019s understanding of equipoise and randomisation in randomised controlled trials","volume":"9","author":"Robinson","year":"2005","journal-title":"Health Technol Assess"},{"key":"key2016101214380664_ref1-bib87","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/j.1365-2648.2007.04471.x","article-title":"Professional nursing culture on a trauma unit: experiences of patients and staff","volume":"61","author":"Tutton","year":"2008","journal-title":"J Adv Nurs"},{"key":"key2016101214380664_ref1-bib88","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1016\/j.ijnurstu.2012.01.013","article-title":"Hope in orthopaedic trauma: a qualitative study","volume":"49","author":"Tutton","year":"2012","journal-title":"Int J Nurs Stud"},{"key":"key2016101214380664_ref1-bib89","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/j.injury.2012.12.025","article-title":"Improving recovery-Learning from patients\u2019 experiences after injury: a qualitative study","volume":"45","author":"Sleney","year":"2014","journal-title":"Injury"},{"key":"key2016101214380664_ref1-bib90","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1046\/j.1365-2648.1998.00847.x","article-title":"Thinking of the future and walking back to normal: an exploratory study of patients\u2019 experiences during recovery from lower limb fracture","volume":"28","author":"Griffiths","year":"1998","journal-title":"J Adv Nurs"},{"key":"key2016101214380664_ref1-bib91","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1016\/j.injury.2012.01.027","volume":"43","author":"Trickett","year":"2012","journal-title":"Injury"},{"key":"key2016101214380664_ref1-bib92","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1111\/jocn.12292","article-title":"People\u2019s experiences of suffering a lower limb fracture and undergoing surgery","volume":"23","author":"Forsberg","year":"2014","journal-title":"J Clin Nurs"},{"key":"key2016101214380664_ref1-bib93","volume-title":"Researching Lived Experience, Human Science for an Action Sensitive Pedagogy","author":"Van Manen","year":"1990"},{"key":"key2016101214380664_ref1-bib94","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/S0020-7489(00)00047-X","article-title":"The complementarity of phenomenology, hermeneutics and existentialism as a philosophical perspective for nursing research","volume":"38","author":"Todres","year":"2001","journal-title":"Int J Nurs Stud"},{"key":"key2016101214380664_ref1-bib95","volume-title":"Being and Time","author":"Heidegger","year":"1962"},{"key":"key2016101214380664_ref1-bib96","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.ijnurstu.2004.06.011","article-title":"Phenomenological nursing research: methodological insights derived from Heidegger\u2019s interpretive phenomenology","volume":"42","author":"Mackey","year":"2005","journal-title":"Int J Nurs Stud"},{"key":"key2016101214380664_ref1-bib97","volume-title":"Nursing and the Experience of Illness, Phenomenology in Practice","author":"Madjar","year":"1999"},{"key":"key2016101214380664_ref1-bib98","volume-title":"Interpretive Phenomenology, Embodiment, Loving and Ethics in Health and Illness","author":"Leonard","year":"1994"},{"key":"key2016101214380664_ref1-bib99","doi-asserted-by":"crossref","DOI":"10.1016\/0147-1767(85)90062-8","volume-title":"Naturalistic Inquiry","author":"Lincoln","year":"1985"},{"key":"key2016101214380664_ref1-bib100","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1177\/1049732308320113","article-title":"Failing bodies: body image and multiple chronic conditions in later life","volume":"18","author":"Clarke","year":"2008","journal-title":"Qual Health Res"},{"key":"key2016101214380664_ref1-bib101","doi-asserted-by":"crossref","DOI":"10.2307\/j.ctt9qgvq4","volume-title":"Fracture, Adventures of a Broken Body","author":"Oakley","year":"2007"},{"key":"key2016101214380664_ref1-bib102","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/j.1547-5069.1999.tb00455.x","article-title":"Linking concepts of enduring, uncertainty, suffering, and hope","volume":"31","author":"Morse","year":"1999","journal-title":"Image J Nurs Sch"},{"key":"key2016101214380664_ref1-bib103","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1177\/1359104509339545","article-title":"Test of time: a case study in the functioning of social systems as a defence against anxiety: rereading 50 years on","volume":"14","author":"Lawlor","year":"2009","journal-title":"Clin Child Psychol Psychiatry"},{"key":"key2016101214380664_ref1-bib104","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1177\/1049732303257224","article-title":"Living with bodily strangeness: women\u2019s experiences of their changing and unpredictable body following a stroke","volume":"13","author":"Kvigne","year":"2003","journal-title":"Qual Health Res"},{"key":"key2016101214380664_ref1-bib105","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1111\/1467-9566.ep11339939","article-title":"Chronic illness as biographical disruption","volume":"4","author":"Bury","year":"1982","journal-title":"Sociol Health Ill"},{"key":"key2016101214380664_ref1-bib106","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1111\/1467-9566.00191","article-title":"Chronic illness as biographical disruption or biographical disruption as chronic illness? Reflections on a core concept","volume":"22","author":"Williams","year":"2000","journal-title":"Sociol Health Ill"},{"key":"key2016101214380664_ref1-bib107","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1177\/1049732314542809","article-title":"Self-reflective meaning making in troubled times: change in self-identity after traumatic brain injury","volume":"24","author":"Thomas","year":"2014","journal-title":"Qual Health Res"},{"key":"key2016101214380664_ref1-bib108","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1111\/j.1365-2524.2008.00836.x","article-title":"Elderly women\u2019s experience of living with fall risk in a fragile body: a reflective lifeworld approach","volume":"17","author":"Hallrup","year":"2009","journal-title":"Health Soc Care Community"},{"key":"key2016101214380664_ref1-bib109","doi-asserted-by":"publisher","first-page":"2720","DOI":"10.1016\/j.socscimed.2005.11.009","article-title":"Making the invisible body visible. Bone scans, osteoporosis and women\u2019s bodily experiences","volume":"62","author":"Reventlow","year":"2006","journal-title":"Soc Sci Med"},{"key":"key2016101214380664_ref1-bib110","doi-asserted-by":"crossref","first-page":"690","DOI":"10.2519\/jospt.2014.5294","article-title":"Early ankle movement versus immobilization in the postoperative management of ankle fracture in adults: a systematic review and meta-analysis","volume":"44","author":"Keene","year":"2014","journal-title":"J Orthop Sports Phys Ther"},{"key":"key2016101214380664_ref1-bib111","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1136\/bjsports-2011-090497","article-title":"A systematic review of patient-reported outcome measures used to assess Achilles tendon rupture management: what\u2019s being used and should we be using it?","volume":"46","author":"Kearney","year":"2012","journal-title":"Br J Sports Med"},{"key":"key2016101214380664_ref1-bib112","doi-asserted-by":"publisher","first-page":"72","DOI":"10.2519\/jospt.2007.2403","article-title":"A survey of self-reported outcome instruments for the foot and ankle","volume":"37","author":"Martin","year":"2007","journal-title":"J Orthop Sports Phys Ther"},{"key":"key2016101214380664_ref1-bib113","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/1471-2474-14-109","article-title":"The Swedish version of OMAS is a reliable and valid outcome measure for patients with ankle fractures","volume":"14","author":"Nilsson","year":"2013","journal-title":"BMC Musculoskelet Disord"},{"key":"key2016101214380664_ref1-bib114","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1302\/0301-620X.96B5.33143","article-title":"A case\u2013control study of surgical site infection following operative fixation of fractures of the ankle in a large UK trauma unit","volume":"96-b","author":"Korim","year":"2014","journal-title":"Bone Joint J"},{"key":"key2016101214380664_ref1-bib115","doi-asserted-by":"publisher","first-page":"348","DOI":"10.2106\/JBJS.K.01672","article-title":"Risk factors for deep surgical site infection following operative treatment of ankle fractures","volume":"95","author":"Ovaska","year":"2013","journal-title":"J Bone Joint Surg Am"},{"key":"key2016101214380664_ref1-bib116","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1515\/bmt-2014-0069","article-title":"Quantitative biomechanical comparison of ankle fracture casting methods","volume":"60","author":"Shipman","year":"2015","journal-title":"Biomed Tech"},{"key":"key2016101214380664_ref1-bib117","doi-asserted-by":"publisher","first-page":"1757","DOI":"10.1007\/s00264-012-1556-z","article-title":"Nonunion of fibula: a systematic review","volume":"36","author":"Bhadra","year":"2012","journal-title":"Int Orthop"},{"key":"key2016101214380664_ref1-bib118","volume-title":"The Closed Treatment of Common Fractures","author":"Charnley","year":"1999","edition":"4th edn."},{"key":"key2016101214380664_ref1-bib119","doi-asserted-by":"publisher","first-page":"915","DOI":"10.2106\/JBJS.G.00637","article-title":"The burden of musculoskeletal injury in low and middle-income countries: challenges and opportunities","volume":"90","author":"Spiegel","year":"2008","journal-title":"J Bone Joint Surg Am"},{"key":"key2016101214380664_ref1-bib120","doi-asserted-by":"publisher","first-page":"2306","DOI":"10.1007\/s11999-008-0416-z","article-title":"The global burden of musculoskeletal injuries: challenges and solutions","volume":"466","author":"Mock","year":"2008","journal-title":"Clin Orthop Relat Res"},{"key":"key2016101214380664_ref1-bib121","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/1745-6215-11-78","article-title":"Managing clinical trials","volume":"11","author":"Farrell","year":"2010","journal-title":"Trials"}],"container-title":["Health Technology Assessment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta20750\/hta20750.xml","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2002540","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta20750\/hta20750.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2003456","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T15:48:51Z","timestamp":1692114531000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/hta\/hta20750\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10]]},"references-count":121,"journal-issue":{"issue":"75","published-online":{"date-parts":[[2016,10]]}},"alternative-id":["10.3310\/hta20750"],"URL":"https:\/\/doi.org\/10.3310\/hta20750","relation":{},"ISSN":["1366-5278","2046-4924"],"issn-type":[{"value":"1366-5278","type":"print"},{"value":"2046-4924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10]]},"assertion":[{"value":"This content has been made freely available to all.","name":"free","label":"Free to read"}]}}