{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:15:44Z","timestamp":1785820544628,"version":"3.56.0"},"reference-count":42,"publisher":"National Institute for Health and Care Research","issue":"31","license":[{"start":{"date-parts":[[2017,5,1]],"date-time":"2017-05-01T00:00:00Z","timestamp":1493596800000},"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":["11\/129\/148"],"award-info":[{"award-number":["11\/129\/148"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"\n Background<\/jats:title>\n Transverse myelitis (TM) is an immune-mediated disorder of the spinal cord that affects adults and children and that causes motor, sensory and autonomic dysfunction. There is a prolonged recovery phase, which may continue for many years. Neuromyelitis optica (NMO) is an uncommon relapsing inflammatory central nervous system condition in which TM can be the first presenting symptom. As TM and NMO affect many patients in the prime of their working life, the disorder can impose a significant demand on health resources. There are currently no robust controlled trials in children or adults to inform the optimal treatment of TM. However, treatment with intravenous immunoglobulin (IVIG) is being effectively used in the management of a range of neurological conditions. Although other interventions such as plasma exchange (PLEX) in addition to intravenous (IV) methylprednisolone therapy can be beneficial in TM, PLEX is costly and technically challenging to deliver in the acute setting. IVIG is more readily accessible and less costly.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate whether additional and early treatment with IVIG is of extra benefit in TM compared with standard therapy with IV steroids.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A multicentre, single-blind, parallel-group randomised controlled trial of IVIG compared with standard therapy for the treatment of TM in adults and children.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Patients aged \u2265\u20091 year diagnosed with either acute first-onset TM or first presentation of NMO. Target recruitment was 170 participants (85 participants per arm).<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were randomised 1\u2009:\u20091 to treatment with IV methylprednisolone only or treatment with IV methylprednisolone plus 2\u2009g\/kg of IVIG in divided doses within 5 days of the first commencement of steroid therapy.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n Primary outcome measure \u2013 American Spinal Injury Association (ASIA) Impairment Scale at 6 months post randomisation, with a good outcome defined by a two-grade change. Secondary and tertiary outcome measures \u2013 ASIA motor and sensory scales, Expanded Disability Status Scale, health outcome, quality of life, Client Service Receipt Inventory and International Spinal Cord Injury Pain, Bladder and Bowel Basic Data Sets.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In total, 26 participants were screened and two were randomised into the study. With the limited sample size, treatment effect could not be determined. However, we identified barriers to accrual that included strict inclusion criteria, the short enrolment window, challenges associated with the use of the ASIA Impairment Scale as an outcome measure and estimation of the incidence of TM.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The study did not reach the end point and the effect of IVIG in TM\/NMO could not be determined. Investigators should be aware of the potential challenges associated with carrying out a rare disease trial with a short enrolment window. The study question is one that still necessitates investigation. Preliminary work to ameliorate the effect of the barriers encountered in this study is vital.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n EudraCT 2014-002335-34, ClinicalTrials.gov NCT02398994 and Current Controlled Trials ISRCTN12127581.<\/jats:p>\n <\/jats:sec>\n \n Funding<\/jats:title>\n This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment<\/jats:italic>; Vol. 21, No. 31. See the NIHR Journals Library website for further project information. Funding was also received from Biotest AG, Germany (supply of IVIG) and the Transverse Myelitis Society (excess research cost to facilitate study initiation).<\/jats:p>\n <\/jats:sec>","DOI":"10.3310\/hta21310","type":"journal-article","created":{"date-parts":[[2017,6,22]],"date-time":"2017-06-22T14:08:20Z","timestamp":1498140500000},"page":"1-50","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["A multicentre randomiSed controlled TRial of IntraVEnous immunoglobulin compared with standard therapy for the treatment of transverse myelitis in adults and children (STRIVE)"],"prefix":"10.3310","volume":"21","clinical-trial-number":[{"clinical-trial-number":"nct02398994","registry":"10.18810\/clinical-trials-gov","type":"results"},{"clinical-trial-number":"isrctn12127581","registry":"10.18810\/isrctn","type":"results"}],"author":[{"given":"Michael","family":"Absoud","sequence":"first","affiliation":[{"name":"Department of Children\u2019s Neurosciences, Evelina Children\u2019s Hospital at Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, King\u2019s Health Partners Academic Health Science Centre, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Brex","sequence":"additional","affiliation":[{"name":"Department of Neurology, King\u2019s College Hospital NHS Foundation Trust, King\u2019s Health Partners Academic Health Science Centre, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Ciccarelli","sequence":"additional","affiliation":[{"name":"University College London Institute of Neurology, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onyinye","family":"Diribe","sequence":"additional","affiliation":[{"name":"Department of Children\u2019s Neurosciences, Evelina Children\u2019s Hospital at Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, King\u2019s Health Partners Academic Health Science Centre, London, UK"},{"name":"King\u2019s Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Giovannoni","sequence":"additional","affiliation":[{"name":"Centre for Neuroscience and Trauma, Blizard Institute, University of London and Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Hellier","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary","family":"Howe","sequence":"additional","affiliation":[{"name":"King\u2019s Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Holland","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Kelly","sequence":"additional","affiliation":[{"name":"King\u2019s Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"McCrone","sequence":"additional","affiliation":[{"name":"Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Murphy","sequence":"additional","affiliation":[{"name":"King\u2019s Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackie","family":"Palace","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oxford University Hospitals NHS Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Pickles","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Pike","sequence":"additional","affiliation":[{"name":"Department of Paediatric Neurology, Oxford University Hospitals NHS Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Robertson","sequence":"additional","affiliation":[{"name":"Institute of Psychological Medicine and Clinical Neurosciences, Cardiff and Vale University Health Board, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anu","family":"Jacob","sequence":"additional","affiliation":[{"name":"The Walton Centre, Walton Centre NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Children\u2019s Neurosciences, Evelina Children\u2019s Hospital at Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, King\u2019s Health Partners Academic Health Science Centre, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2017,5]]},"reference":[{"key":"key201705291327028_ref1-bib1","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/00019052-200206000-00019","article-title":"Immunopathogenesis of acute transverse myelitis","volume":"15","author":"Kerr","year":"2002","journal-title":"Curr Opin Neurol"},{"key":"key201705291327028_ref1-bib2","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/j.autrev.2011.05.018","article-title":"Transverse myelitis","volume":"11","author":"Borchers","year":"2012","journal-title":"Autoimmun Rev"},{"key":"key201705291327028_ref1-bib3","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1212\/WNL.59.4.499","article-title":"Proposed diagnostic criteria and nosology of acute transverse myelitis","volume":"59","author":"Transverse Myelitis Consortium Working Group","year":"2002","journal-title":"Neurology"},{"key":"key201705291327028_ref1-bib4","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1136\/jnnp-2012-302310","article-title":"Current concept of neuromyelitis optica (NMO) and NMO spectrum disorders","volume":"84","author":"Jacob","year":"2013","journal-title":"J Neurol Neurosurg Psychiatr"},{"key":"key201705291327028_ref1-bib5","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1001\/archneur.1963.00460080021002","article-title":"Acute transverse myelopathy","volume":"9","author":"Altrocchi","year":"1963","journal-title":"Arch Neurol"},{"key":"key201705291327028_ref1-bib6","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/01.nrl.0000149975.39201.0b","article-title":"Diagnosis and management of acute myelopathies","volume":"11","author":"Kaplin","year":"2005","journal-title":"Neurologist"},{"key":"key201705291327028_ref1-bib7","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1212\/01.wnl.0000188896.48308.26","article-title":"Idiopathic acute transverse myelitis: application of the recent diagnostic criteria","volume":"65","author":"de Seze","year":"2005","journal-title":"Neurology"},{"key":"key201705291327028_ref1-bib8","first-page":"152","volume-title":"Disorders of the Spinal Cord in Children","author":"Absoud","year":"2013"},{"key":"key201705291327028_ref1-bib9","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1177\/1352458509345906","article-title":"Clinically isolated acute transverse myelitis: prognostic features and incidence","volume":"15","author":"Young","year":"2009","journal-title":"Mult Scler"},{"key":"key201705291327028_ref1-bib10","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1177\/1352458512445944","article-title":"Paediatric acquired demyelinating syndromes: incidence, clinical and magnetic resonance imaging features","volume":"19","author":"Absoud","year":"2013","journal-title":"Mult Scler"},{"key":"key201705291327028_ref1-bib11","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1212\/01.wnl.0000260970.63493.c8","article-title":"Idiopathic transverse myelitis: corticosteroids, plasma exchange, or cyclophosphamide","volume":"68","author":"Greenberg","year":"2007","journal-title":"Neurology"},{"key":"key201705291327028_ref1-bib12","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1056\/NEJMcp1001112","article-title":"Clinical practice. Transverse myelitis","volume":"363","author":"Frohman","year":"2010","journal-title":"N Engl J Med"},{"key":"key201705291327028_ref1-bib13","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1212\/WNL.0b013e31823dc535","article-title":"Evidence-based guideline: clinical evaluation and treatment of transverse myelitis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology","volume":"77","author":"Scott","year":"2011","journal-title":"Neurology"},{"key":"key201705291327028_ref1-bib14","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1002\/1531-8249(199912)46:6<878::AID-ANA10>3.0.CO;2-Q","article-title":"A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease","volume":"46","author":"Weinshenker","year":"1999","journal-title":"Ann Neurol"},{"key":"key201705291327028_ref1-bib15","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1111\/j.1365-2249.2009.04025.x","article-title":"Clinical applications of intravenous immunoglobulins in neurology","volume":"158","author":"Hughes","year":"2009","journal-title":"Clin Exp Immunol"},{"key":"key201705291327028_ref1-bib16","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/S1474-4422(07)70242-9","article-title":"Multiple sclerosis in children: clinical diagnosis, therapeutic strategies, and future directions","volume":"6","author":"Banwell","year":"2007","journal-title":"Lancet Neurol"},{"key":"key201705291327028_ref1-bib17","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1177\/1352458513495938","article-title":"Role of intravenous immunoglobulin in the treatment of acute relapses of neuromyelitis optica: experience in 10 patients","volume":"20","author":"Elsone","year":"2014","journal-title":"Mult Scler"},{"key":"key201705291327028_ref1-bib18","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1212\/WNL.51.6_Suppl_5.S2","article-title":"Mechanism of action of intravenous immunoglobulin and therapeutic considerations in the treatment of autoimmune neurologic diseases","volume":"51","author":"Dalakas","year":"1998","journal-title":"Neurology"},{"key":"key201705291327028_ref1-bib19","doi-asserted-by":"crossref","first-page":"417","DOI":"10.2174\/157015911796557948","article-title":"Idiopathic transverse myelitis and neuromyelitis optica: clinical profiles, pathophysiology and therapeutic choices","volume":"9","author":"Awad","year":"2011","journal-title":"Curr Neuropharmacol"},{"key":"key201705291327028_ref1-bib20","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1038\/sj.sc.3102008","article-title":"Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures","volume":"45","author":"Steeves","year":"2007","journal-title":"Spinal Cord"},{"key":"key201705291327028_ref1-bib21","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1038\/sj.sc.3102044","article-title":"Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards","volume":"45","author":"Savic","year":"2007","journal-title":"Spinal Cord"},{"key":"key201705291327028_ref1-bib22","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1177\/1352458512461968","article-title":"Analysis of prognostic factors associated with longitudinally extensive transverse myelitis","volume":"19","author":"Sep\u00fclveda","year":"2013","journal-title":"Mult Scler"},{"key":"key201705291327028_ref1-bib23","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12955-017-0590-3","article-title":"The use of the EQ-5D-Y health related quality of life outcome measure in children in the Western Cape, South Africa: psychometric properties, feasibility and usefulness \u2013 a longitudinal, analytical study","volume":"15","author":"Scott","year":"2017","journal-title":"Health Qual Life Outcomes"},{"key":"key201705291327028_ref1-bib24","doi-asserted-by":"crossref","first-page":"2481","DOI":"10.1007\/s11136-016-1297-3","article-title":"Health state descriptions, valuations and individuals\u2019 capacity to walk: a comparative evaluation of preference-based instruments in the context of spinal cord injury","volume":"25","author":"Whitehurst","year":"2016","journal-title":"Qual Life Res"},{"key":"key201705291327028_ref1-bib25","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1038\/sj.sc.3101930","article-title":"International Spinal Cord Injury Data Sets","volume":"44","author":"Biering-S\u00f8rensen","year":"2006","journal-title":"Spinal Cord"},{"key":"key201705291327028_ref1-bib26","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/ene.12245","article-title":"Economic costs and quality of life in chronic inflammatory neuropathies in southeast England","volume":"21","author":"Mahdi-Rogers","year":"2014","journal-title":"Eur J Neurol"},{"key":"key201705291327028_ref1-bib27","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1038\/sc.2011.23","article-title":"Reliability of the International Spinal Cord Injury Bowel Function Basic and Extended Data Sets","volume":"49","author":"Juul","year":"2011","journal-title":"Spinal Cord"},{"key":"key201705291327028_ref1-bib28","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1038\/sc.2013.72","article-title":"International Spinal Cord Injury Urinary Tract Infection Basic Data Set","volume":"51","author":"Goetz","year":"2013","journal-title":"Spinal Cord"},{"key":"key201705291327028_ref1-bib29","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1177\/1367493512448127","article-title":"The PedsQL as a measure of parent-rated quality of life in healthy UK toddlers: psychometric properties and cross-cultural comparisons","volume":"16","author":"Buck","year":"2012","journal-title":"J Child Health Care"},{"key":"key201705291327028_ref1-bib30","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1097\/PEP.0b013e31815a12ef","article-title":"Quality of life in children with spinal cord injury","volume":"19","author":"Oladeji","year":"2007","journal-title":"Pediatr Phys Ther"},{"key":"key201705291327028_ref1-bib31","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1038\/sc.2015.219","article-title":"Pain assessment according to the International Spinal Cord Injury Pain classification in patients with spinal cord injury referred to a multidisciplinary pain center","volume":"54","author":"Mahnig","year":"2016","journal-title":"Spinal Cord"},{"key":"key201705291327028_ref1-bib32","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1212\/01.wnl.0000216139.44259.74","article-title":"Revised diagnostic criteria for neuromyelitis optica","volume":"66","author":"Wingerchuk","year":"2006","journal-title":"Neurology"},{"key":"key201705291327028_ref1-bib33","doi-asserted-by":"crossref","first-page":"e008312","DOI":"10.1136\/bmjopen-2015-008312","article-title":"Protocol for a multicentre randomiSed controlled TRial of IntraVEnous immunoglobulin versus standard therapy for the treatment of transverse myelitis in adults and children (STRIVE)","volume":"5","author":"Absoud","year":"2015","journal-title":"BMJ Open"},{"key":"key201705291327028_ref1-bib34","volume-title":"Good Clinical Practice for Clinical Trials","author":"Medicines and Healthcare products Regulatory Agency","year":"2014"},{"key":"key201705291327028_ref1-bib35","volume-title":"CFR \u2013 Code of Federal Regulations Title 21","author":"US Food and Drug Administration"},{"key":"key201705291327028_ref1-bib36","volume-title":"Medicinal Products for Human Use","author":"European Commission"},{"key":"key201705291327028_ref1-bib37","volume-title":"Statutory Instruments: 2004 No. 1031 \u2013 Medicines. The Medicines for Human Use (Clinical Trials) Regulations 2004 \u2013 Regulation 46(2)","author":"Great Britain","year":"2004"},{"key":"key201705291327028_ref1-bib38","volume-title":"Data Protection Act 1998","author":"Great Britain","year":"1998"},{"key":"key201705291327028_ref1-bib39","doi-asserted-by":"publisher","first-page":"d40","DOI":"10.1136\/bmj.d40","article-title":"Strategy for intention to treat analysis in randomised trials with missing outcome data","volume":"342","author":"White","year":"2011","journal-title":"BMJ"},{"key":"key201705291327028_ref1-bib40","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1046\/j.1351-5101.2003.00701.x","article-title":"Cost\u2013utility analysis of intravenous immunoglobulin and prednisolone for chronic inflammatory demyelinating polyradiculoneuropathy","volume":"10","author":"McCrone","year":"2003","journal-title":"Eur J Neurol"},{"key":"key201705291327028_ref1-bib41","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1186\/s13023-014-0170-0","article-title":"A comparison of interventional clinical trials in rare versus non-rare diseases: an analysis of ClinicalTrials.gov","volume":"9","author":"Bell","year":"2014","journal-title":"Orphanet J Rare Dis"},{"key":"key201705291327028_ref1-bib42","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.ymgme.2008.10.003","article-title":"Clinical research for rare disease: opportunities, challenges, and solutions","volume":"96","author":"Griggs","year":"2009","journal-title":"Mol Genet Metab"}],"container-title":["Health Technology Assessment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta21310\/hta21310.xml","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2002714","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta21310\/hta21310.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2010544","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T15:49:29Z","timestamp":1692114569000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/hta\/hta21310"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5]]},"references-count":42,"journal-issue":{"issue":"31","published-online":{"date-parts":[[2017,5]]}},"alternative-id":["10.3310\/hta21310"],"URL":"https:\/\/doi.org\/10.3310\/hta21310","relation":{},"ISSN":["1366-5278","2046-4924"],"issn-type":[{"value":"1366-5278","type":"print"},{"value":"2046-4924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5]]},"assertion":[{"value":"This content has been made freely available to all.","name":"free","label":"Free to read"}]}}