464, 95% CI -0.198 to 3.127) and Avant-Garde (∆k€0.636, 95% CI -0.987 to 2.258) were more expensive compared with Slim and QALYs were slightly worse for Classic (∆-0.002, 95% CI -0.086 to 0.082) and Avant-Garde (∆-0.009, 95% CI -0.102 to 0.084). This resulted in the domination of Classic and Avant-Garde by Slim. In the low-risk group, Slim was cheaper (∆k€-0.617, 95% CI -2.799 to 1.566) and QALYs were higher (∆0.141, 95% CI 0.008 to 0.274) compared with TSU, indicating Slim dominated. Results were robust against the price of biosimilars. CONCLUSIONS The combination of MTX with a GC bridging scheme is less expensive with comparable health utility than more intensive step-down combination strategies or a conventional step-up approach 2 years after initial treatment. TRIAL REGISTRATION NUMBER NCT01172639. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVES To compare days on sick leave and assess predictors of return to work following shoulder surgery. DESIGN A secondary analysis of a randomised controlled trial. SETTING Orthopaedic department. PARTICIPANTS 114 patients with type II superior labral tear from anterior to posterior of the shoulder. INTERVENTIONS Labral repair, biceps tenodesis or sham surgery. OUTCOME MEASURES Sick leave was obtained from national registers for the last year before and 2 years following surgery. Total and shoulder related number of days on sick leave were obtained, using international diagnostic codes. We applied the difference-in-difference approach to compare the differences in the change in mean work days on sick leave between groups over time, backwards logistic regression and lasso regression to evaluate predictors. RESULTS Mean total number of work days on sick leave during the 2 years after surgery was 148 (range 0-460) days. More than 80% of the sick leave days were taken by 22% of the patients. Days on sick le 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.INTRODUCTION Acupuncture is safe and effective for improving the motor function of poststroke hemiplegic patients, but there still exists a certain gap between clinical practice and understanding its neural mechanisms. The cerebral functional reconstruction after unilateral motor pathway injury exhibits a bilateral tendency, however current studies seldom pay attention to it. Hence, based on cerebral bilateral connections, the underlying mechanism of acupuncture in stroke rehabilitation remains an area for further research. The results of this study will increase our understanding of acupuncture-induced motor recovery in patients who had suffered a stroke and demonstrate the differences in brain response and clinical assessments. METHODS AND ANALYSIS This is a single-centre, randomised controlled, paralleled neuroimaging trial, with patients and outcome assessors blinded. Thirty patients who had a stroke with motor dysfunction meeting the inclusion criteria will be randomly assigned (21) to receive either 10 (DZMEC-KY-2018-04). The results of the neuroimaging trial will be disseminated through peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trials Registry (ChiCTR 1800016263). © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.INTRODUCTION Physical functioning (PF) is the ability to carry out the physical activity of daily living. It is an important outcome that provides a meaningful evaluation of individuals' life. PF can be assessed using patient-reported outcome measures, performance-based outcome measures or body structure and function measure. Measures need to be valid, reliable and responsive to change to evaluate the effects of an intervention. Adolescent idiopathic scoliosis (AIS) is the most common deformity among the paediatric population and impacts on individuals' lives. This systematic review will appraise evidence on the measurement properties of PF tools in individuals with AIS.  https://www.selleckchem.com/products/jnj-64619178.html  METHODS/ANALYSIS A protocol for systematic review and meta-analysis informed by Cochrane guidelines is reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P. MEDLINE, PsycINFO, EMBASE, CINAHL, SPORTdiscus, Web of Science and PubMed will be searched in two stages, from inception until December 2019. Search minated through a peer-reviewed publication and conference presentation. PROSPERO REGISTRATION NUMBER CRD42019142335. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVES We aimed to develop and internally validate a measure of multimorbidity burden using data from the Canadian Longitudinal Study on Aging (CLSA). DESIGN Data from 40 264 CLSA participants (52% men) aged 45-85 years (a mean of 63 years) were analysed. We used logistic regression models to predict overnight hospitalisation in the last 12 months in the development dataset (random two-thirds of the total) and used these to construct 10 multimorbidity indices (5 models, each treated with and without an age interaction term). Thirty-five chronic conditions were considered for inclusion in these models, in addition to age and sex. We assessed predictive and convergent validity for these 10 different multimorbidity indices in the validation dataset (remaining one-third of the total). RESULTS The absolute count of chronic conditions plus an interaction with age, displayed strong calibration properties, outperforming other candidate indices. Discrimination was modest for all of the indices that we internally validated, with C-statistics ranging from 0.66 to 0.68. The indices showed weak correlations (ie, convergent validity) with satisfaction with life, functional disability and mental health (absolute Pearson's correlation coefficients ranging from 0.11 to 0.30) but generally moderate correlations with self-rated general health (0.32-0.45). CONCLUSIONS We investigated alternative methods to measure the multimorbidity burden of individuals, tailored to the CLSA. Our findings show that an absolute count of conditions, along with an age interaction term, has the strongest calibration for overnight hospitalisation in the last 12 months. The utility of an age interaction term in measuring multimorbidity burden may be applicable to the study of chronic disease in cohorts other than the CLSA. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.