Richard (Rick) Deyo

Professor

  • 54878 Citations
  • 116 h-Index
1973 …2018
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Research Output 1973 2018

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Article
2018

Associations of Early Opioid Use with Patient-reported Outcomes and Health Care Utilization among Older Adults with Low Back Pain

Gold, L. S., Hansen, R. N., Avins, A. L., Bauer, Z., Comstock, B. A., Deyo, R. A., Heagerty, P. J., Rundell, S. D., Suri, P., Turner, J. A. & Jarvik, J. G., Jan 1 2018, In : Clinical Journal of Pain. 34, 4, p. 297-305 9 p., 0557

Research output: Contribution to journalArticle

Patient Acceptance of Health Care
Low Back Pain
Opioid Analgesics
Prescriptions
Back Pain

Comparative Effectiveness of Usual Care With or Without Chiropractic Care in Patients with Recurrent Musculoskeletal Back and Neck Pain

Elder, C., DeBar, L., Ritenbaugh, C., Dickerson, J., Vollmer, W. M., Deyo, R. A., Johnson, E. S. & Haas, M., Jun 25 2018, (Accepted/In press) In : Journal of General Internal Medicine. p. 1-9 9 p.

Research output: Contribution to journalArticle

Chiropractic
Musculoskeletal Pain
Neck Pain
Back Pain
Patient Care

Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy

Lozier, C. C., Nugent, S. M., Smith, N. X., Yarborough, B. J., Dobscha, S. K., Deyo, R. A. & Morasco, B. J., May 1 2018, In : Journal of General Internal Medicine. 33, p. 46-53 8 p.

Research output: Contribution to journalArticle

Chronic Pain
Opioid Analgesics
Therapeutics
Pain
Demography

Effect of a high dosage opioid prior authorization policy on prescription opioid use, misuse, and overdose outcomes

Hartung, D. M., Kim, H., Ahmed, S. M., Middleton, L., Keast, S., Deyo, R. A., Zhang, K. & McConnell, K. J., May 14 2018, (Accepted/In press) In : Substance Abuse. p. 1-8 8 p.

Research output: Contribution to journalArticle

Opioid Analgesics
Prescriptions
Confidence Intervals
Morphine
Medicaid

Effects of a prior authorization policy for extended-release/long-acting opioids on utilization and outcomes in a state Medicaid program

Keast, S. L., Kim, H., Deyo, R. A., Middleton, L., McConnell, K. J., Zhang, K., Ahmed, S. M., Nesser, N. & Hartung, D. M., Sep 1 2018, In : Addiction. 113, 9, p. 1651-1660 10 p.

Research output: Contribution to journalArticle

Medicaid
Opioid Analgesics
Prescriptions
Confidence Intervals
Hospital Emergency Service
2 Citations

High-risk prescribing and opioid overdose: Prospects for prescription drug monitoring program-based proactive alerts

Geissert, P., Hallvik, S., Van Otterloo, J., O'Kane, N., Alley, L., Carson, J., Leichtling, G., Hildebran, C., Wakeland, W. & Deyo, R. A., Jan 1 2018, In : Pain. 159, 1, p. 150-156 7 p.

Research output: Contribution to journalArticle

Prescription Drugs
Drug Monitoring
Opioid Analgesics
Prescriptions
ROC Curve

Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) – Protocol for a pragmatic cluster randomized trial

DeBar, L., Benes, L., Bonifay, A., Deyo, R. A., Elder, C. R., Keefe, F. J., Leo, M. C., McMullen, C., Mayhew, M., Owen-Smith, A., Smith, D. H., Trinacty, C. M. & Vollmer, W. M., Apr 1 2018, In : Contemporary Clinical Trials. 67, p. 91-99 9 p.

Research output: Contribution to journalArticle

Pragmatic Clinical Trials
Patient Care Team
Chronic Pain
Opioid Analgesics
Primary Health Care

Long-term outcomes of a large, prospective observational cohort of older adults with back pain

Jarvik, J. G., Gold, L. S., Tan, K., Friedly, J. L., Nedeljkovic, S. S., Comstock, B. A., Deyo, R. A., Turner, J. A., Bresnahan, B. W., Rundell, S. D., James, K. T., Nerenz, D. R., Avins, A. L., Bauer, Z., Kessler, L. & Heagerty, P. J., Jan 1 2018, (Accepted/In press) In : Spine Journal.

Research output: Contribution to journalArticle

Back Pain
Confidence Intervals
Pain
Primary Health Care
Age Groups
1 Citations

Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy

Nugent, S. M., Yarborough, B. J., Smith, N. X., Dobscha, S. K., Deyo, R. A., Green, C. A. & Morasco, B. J., Jan 1 2018, In : General Hospital Psychiatry. 50, p. 104-110 7 p.

Research output: Contribution to journalArticle

Medical Marijuana
Opioid Analgesics
Pain
Therapeutics
Nicotine

Prevalence and Correlates of Low Pain Interference Among Patients With High Pain Intensity Who Are Prescribed Long-Term Opioid Therapy

Adams, M. H., Dobscha, S. K., Smith, N. X., Yarborough, B. J., Deyo, R. A. & Morasco, B. J., Jan 1 2018, (Accepted/In press) In : Journal of Pain.

Research output: Contribution to journalArticle

Opioid Analgesics
Pain
Therapeutics
Self Efficacy
Depression

Use of prescription opioids before and after an operation for chronic pain (lumbar fusion surgery)

Deyo, R. A., Hallvik, S. E., Hildebran, C., Marino, M., O'Kane, N., Carson, J., Van Otterloo, J., Wright, D. A., Millet, L. M. & Wakelan, W., Jan 1 2018, In : Pain. 159, 6, p. 1147-1154 8 p.

Research output: Contribution to journalArticle

Chronic Pain
Opioid Analgesics
Prescriptions
Hospitalization
Prescription Drugs

Variations in prescription drug monitoring program use by prescriber specialty

Sun, B. C., Lupulescu-Mann, N., Charlesworth, C. J., Kim, H., Hartung, D. M., Deyo, R. A. & John McConnell, K., Nov 1 2018, In : Journal of Substance Abuse Treatment. 94, p. 35-40 6 p.

Research output: Contribution to journalArticle

Prescription Drugs
Drug Monitoring
Opioid Analgesics
Physicians
Emergencies
2017
2 Citations

A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Men

Osteoporotic Fractures in Men Study (MrOS) Research Group, Sep 1 2017, In : The journals of gerontology. Series A, Biological sciences and medical sciences. 72, 9, p. 1264-1269 6 p.

Research output: Contribution to journalArticle

Independent Living
Back Pain
Prospective Studies
Odds Ratio
Confidence Intervals
1 Citations

Association of Prescription Drug Monitoring Program Use With Opioid Prescribing and Health Outcomes: A Comparison of Program Users and Nonusers

Deyo, R. A., Hallvik, S. E., Hildebran, C., Marino, M., Springer, R., Irvine, J. M., O'Kane, N., Van Otterloo, J., Wright, D. A., Leichtling, G., Millet, L. M., Carson, J., Wakeland, W. & McCarty, D., Jan 1 2017, (Accepted/In press) In : Journal of Pain.

Research output: Contribution to journalArticle

Prescription Drugs
Drug Monitoring
Opioid Analgesics
Health
Prescriptions
2 Citations

Clinicians' Use of Prescription Drug Monitoring Programs in Clinical Practice and Decision-Making

Leichtling, G. J., Irvine, J. M., Hildebran, C., Cohen, D. J., Hallvik, S. E. & Deyo, R. A., Jun 1 2017, In : Pain medicine (Malden, Mass.). 18, 6, p. 1063-1069 7 p.

Research output: Contribution to journalArticle

Prescription Drugs
Drug Monitoring
Clinical Decision-Making
Primary Health Care
Controlled Substances
1 Citations

Does Prescription Opioid Shopping Increase Overdose Rates in Medicaid Beneficiaries?

Sun, B. C., Lupulescu-Mann, N., Charlesworth, C. J., Kim, H., Hartung, D. M., Deyo, R. A. & McConnell, K. J., Jan 1 2017, (Accepted/In press) In : Annals of Emergency Medicine.

Research output: Contribution to journalArticle

Medicaid
Opioid Analgesics
Prescriptions
Propensity Score
Controlled Substances
2 Citations

Effect of Automated Prescription Drug Monitoring Program Queries on Emergency Department Opioid Prescribing

Sun, B. C., Charlesworth, C. J., Lupulescu-Mann, N., Young, J. I., Kim, H., Hartung, D. M., Deyo, R. A. & McConnell, K. J., Jan 1 2017, (Accepted/In press) In : Annals of Emergency Medicine.

Research output: Contribution to journalArticle

Prescription Drugs
Drug Monitoring
Opioid Analgesics
Hospital Emergency Service
Confidence Intervals
1 Citations

Health Care Systems Support to Enhance Patient-Centered Care: Lessons from a Primary Care-Based Chronic Pain Management Initiative

Elder, C. R., Debar, L. L., Ritenbaugh, C., Rumptz, M. H., Patterson, C., Bonifay, A., Cowan, P., Lancaster, L. & Deyo, R. A., 2017, In : The Permanente journal. 21

Research output: Contribution to journalArticle

Patient-Centered Care
Pain Management
Chronic Pain
Primary Health Care
Delivery of Health Care
5 Citations

Impact of Hospital “Best Practice” Mandates on Prescription Opioid Dispensing After an Emergency Department Visit

Sun, B. C., Lupulescu-Mann, N., Charlesworth, C. J., Kim, H., Hartung, D. M., Deyo, R. A. & John McConnell, K., Aug 1 2017, In : Academic Emergency Medicine. 24, 8, p. 905-913 9 p.

Research output: Contribution to journalArticle

Practice Guidelines
Opioid Analgesics
Prescriptions
Hospital Emergency Service
Confidence Intervals

Measurement Properties of the NIH-minimal Dataset Dutch Language Version in Patients With Chronic Low Back Pain

Boer, A., Dutmer, A. L., Preuper, H. R. S., van der Woude, L. H. V., Stewart, R. E., Deyo, R. A., Reneman, M. F. & Soer, R. Feb 28 2017 (Accepted/In press) In : Spine.

Research output: Contribution to journalArticle

National Institutes of Health (U.S.)
Low Back Pain
Language
Reproducibility of Results
Statistical Factor Analysis
3 Citations

Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: a qualitative study

Penney, L. S., Ritenbaugh, C., DeBar, L. L., Elder, C. & Deyo, R. A., Mar 24 2017, In : BMC Family Practice. 17, 1, 164

Research output: Contribution to journalArticle

Chiropractic
Chronic Pain
Acupuncture
Opioid Analgesics
Pain Management
1 Citations

The feasibility of matching on a propensity score for acupuncture in a prospective cohort study of patients with chronic pain

Johnson, E. S., Dickerson, J. F., Vollmer, W. M., Rowley, A. M., Ritenbaugh, C., Deyo, R. A. & DeBar, L., Mar 16 2017, In : BMC Medical Research Methodology. 17, 1, 42

Research output: Contribution to journalArticle

Propensity Score
Acupuncture
Chronic Pain
Cohort Studies
Prospective Studies
4 Citations

Trends, Complications, and Costs for Hospital Admission and Surgery for Lumbar Spinal Stenosis

Machado, G. C., Maher, C. G., Ferreira, P. H., Harris, I. A., Deyo, R. A., McKay, D., Li, Q. & Ferreira, M. L., Apr 24 2017, (Accepted/In press) In : Spine.

Research output: Contribution to journalArticle

Spinal Stenosis
Hospital Costs
Decompression
Length of Stay
New South Wales

Understanding the value of minimally invasive procedures for the treatment of lumbar spinal stenosis: The case of interspinous spacer devices

Tapp, S. J., Martin, B. I., Tosteson, T. D., Lurie, J. D., Weinstein, M. C., Deyo, R. A., Mirza, S. K. & Tosteson, A. N. A., 2017, (Accepted/In press) In : Spine Journal.

Research output: Contribution to journalArticle

Spinal Stenosis
Cost-Benefit Analysis
Decompression
Quality-Adjusted Life Years
Equipment and Supplies
3 Citations

Using prescription monitoring program data to characterize out-of-pocket payments for opioid prescriptions in a state Medicaid program

Hartung, D. M., Ahmed, S. M., Middleton, L., Van Otterloo, J., Zhang, K., Keast, S., Kim, H., Johnston, K. & Deyo, R. A., 2017, (Accepted/In press) In : Pharmacoepidemiology and Drug Safety.

Research output: Contribution to journalArticle

Medicaid
Health Expenditures
Opioid Analgesics
Prescriptions
Prescription Drugs
2016
6 Citations

A prospective study of back pain and risk of falls among older community-dwelling women

Marshall, L. M., Litwack-Harrison, S., Cawthon, P. M., Kado, D. M., Deyo, R. A., Makris, U. E., Carlson, H. L. & Nevitt, M. C., Sep 1 2016, In : Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 71, 9, p. 1177-1183 7 p.

Research output: Contribution to journalArticle

Independent Living
Back Pain
Prospective Studies
Odds Ratio
Confidence Intervals
31 Citations

Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study

Deyo, R. A., Hallvik, S. E., Hildebran, C., Marino, M., Dexter, E., Irvine, J. M., O’Kane, N., van Otterloo, J., Wright, D. A., Leichtling, G. & Millet, L. M., Aug 2 2016, (Accepted/In press) In : Journal of General Internal Medicine. p. 1-7 7 p.

Research output: Contribution to journalArticle

Opioid Analgesics
Cohort Studies
Retrospective Studies
Prescriptions
Morphine
11 Citations

Bone morphogenetic protein use and cancer risk among patients undergoing lumbar arthrodesis a case-cohort study using the SEER-medicare database

Beachler, D. C., Yanik, E. L., Martin, B. I., Pfeiffer, R. M., Mirza, S. K., Deyo, R. A. & Engels, E. A., Jul 6 2016, In : Journal of Bone and Joint Surgery - American Volume. 98, 13, p. 1064-1072 9 p.

Research output: Contribution to journalArticle

Bone Morphogenetic Proteins
Arthrodesis
Medicare
Epidemiology
Cohort Studies

Can Parsimonious Practice Please Patients and Practitioners? The Case of Spine Imaging

Deyo, R. A., Feb 1 2016, In : Journal of General Internal Medicine. 31, 2, p. 140-141 2 p.

Research output: Contribution to journalArticle

Diagnostic Imaging
Spine
2 Citations

Clinical Styles and Practice Policies: Influence on Communication with Patients Regarding Worrisome Prescription Drug Monitoring Program Data

Hildebran, C., Leichtling, G., Irvine, J. M., Cohen, D. J., Hallvik, S. E. & Deyo, R. A., Nov 1 2016, In : Pain medicine (Malden, Mass.). 17, 11, p. 2061-2066 6 p.

Research output: Contribution to journalArticle

Prescription Drugs
Drug Monitoring
Communication
Practice Guidelines
Interviews
4 Citations

Effects of a Commercial Insurance Policy Restriction on Lumbar Fusion in North Carolina and the Implications for National Adoption

Martin, B. I., Deyo, R. A., Lurie, J. D., Carey, T. S., Tosteson, A. N. A. & Mirza, S. K., Jun 1 2016, In : Spine. 41, 11, p. 647-655 9 p.

Research output: Contribution to journalArticle

Insurance
Inpatients
Spondylolisthesis
Spinal Stenosis
Decompression
23 Citations

Herniated lumbar intervertebral disk

Deyo, R. A. & Mirza, S. K., May 5 2016, In : New England Journal of Medicine. 374, 18, p. 1763-1772 10 p.

Research output: Contribution to journalArticle

Intervertebral Disc
Pain
Leg
Intervertebral Disc Displacement
Ibuprofen
8 Citations

Higher Prescription Opioid Dose is Associated With Worse Patient-Reported Pain Outcomes and More Health Care Utilization

Morasco, B. J., Yarborough, B. J., Smith, N. X., Dobscha, S. K., Deyo, R. A., Perrin, N. A. & Green, C. A., Jul 12 2016, (Accepted/In press) In : Journal of Pain.

Research output: Contribution to journalArticle

Patient Acceptance of Health Care
Opioid Analgesics
Prescriptions
Pain
Morphine

Long-Term Effects of Repeated Injections of Local Anesthetic With or Without Corticosteroid for Lumbar Spinal Stenosis: A Randomized Trial

Friedly, J. L. , Comstock, B. A. , Turner, J. A. , Heagerty, P. J. , Deyo, R. A. , Bauer, Z. , Avins, A. L. , Nedeljkovic, S. S. , Nerenz, D. R. , Shi, X. , Annaswamy, T. , Standaert, C. J. , Smuck, M. , Kennedy, D. J. , Akuthota, V. , Sibell, D. , Wasan, A. D. , Diehn, F. , Suri, P. , Rundell, S. D. & 3 others Kessler, L., Chen, A. S. & Jarvik, J. G., 2016, (Accepted/In press) In : Archives of Physical Medicine and Rehabilitation.

Research output: Contribution to journalArticle

Spinal Stenosis
Lidocaine
Local Anesthetics
Adrenal Cortex Hormones
Injections
47 Citations

Non-steroidal anti-inflammatory drugs for chronic low back pain

Enthoven, W. T. M., Roelofs, P. D. D. M., Deyo, R. A., van Tulder, M. W. & Koes, B. W., Feb 10 2016, In : Cochrane Database of Systematic Reviews. 2016, 2, CD012087

Research output: Contribution to journalArticle

Low Back Pain
Anti-Inflammatory Agents
Pharmaceutical Preparations
Placebos
Back Pain
10 Citations

Performance of a Patient Reported Outcomes Measurement Information System (PROMIS) Short Form in Older Adults with Chronic Musculoskeletal Pain

Deyo, R. A., Katrina Ramsey, R., Buckley, D. I., Michaels, L. A., Kobus, A., Eckstrom, E., Forro, V. & Morris, C., Feb 1 2016, In : Pain medicine (Malden, Mass.). 17, 2, p. 314-324 11 p.

Research output: Contribution to journalArticle

Musculoskeletal Pain
Information Systems
Chronic Pain
Catastrophization
Workers' Compensation
7 Citations

Preparing a prescription drug monitoring program data set for research purposes

O'Kane, N., Hallvik, S. E., Marino, M., Van Otterloo, J., Hildebran, C., Leichtling, G. & Deyo, R. A., Sep 1 2016, In : Pharmacoepidemiology and Drug Safety. 25, 9, p. 993-997 5 p.

Research output: Contribution to journalArticle

Prescription Drugs
Drug Monitoring
Prescriptions
Opioid Analgesics
Research
10 Citations

Primary care physicians, acupuncture and chiropractic clinicians, and chronic pain patients: A qualitative analysis of communication and care coordination patterns

Penney, L. S., Ritenbaugh, C., Elder, C., Schneider, J., Deyo, R. A. & DeBar, L. L., Jan 25 2016, In : BMC Complementary and Alternative Medicine. 16, 1, 30

Research output: Contribution to journalArticle

Chiropractic
Primary Care Physicians
Acupuncture
Musculoskeletal Pain
Chronic Pain
2015
88 Citations

2015 updated method guideline for systematic reviews in the Cochrane Back and Neck Group

Editorial Board of the Cochrane Back, Neck Group, Oct 27 2015, In : Spine. 40, 21, p. 1660-1673 14 p.

Research output: Contribution to journalArticle

Neck
Guidelines
Neck Pain
Back Pain
Somatoform Disorders
7 Citations

Acupuncture and Chiropractic Care: Utilization and Electronic Medical Record Capture

Elder, C., De Bar, L., Ritenbaugh, C., Vollmer, W., Deyo, R. A., Dickerson, J. & Kindler, L., Jul 1 2015, In : American Journal of Managed Care. 21, 7, p. e414-e421

Research output: Contribution to journalArticle

Chiropractic
Electronic Health Records
Acupuncture
Musculoskeletal Pain
Chronic Pain
33 Citations

Association of early imaging for back pain with clinical outcomes in older adults

Jarvik, J. G., Gold, L. S., Comstock, B. A., Heagerty, P. J., Rundell, S. D., Turner, J. A., Avins, A. L., Bauer, Z., Bresnahan, B. W., Friedly, J. L., James, K., Kessler, L., Nedeljkovic, S. S., Nerenz, D. R., Shi, X., Sullivan, S. D., Chan, L., Schwalb, J. M. & Deyo, R. A., Mar 17 2015, In : JAMA - Journal of the American Medical Association. 313, 11, p. 1143-1153 11 p.

Research output: Contribution to journalArticle

Back Pain
Tomography
Magnetic Resonance Imaging
Pain
Primary Health Care
4 Citations

Biopsychosocial care for chronic back pain

Deyo, R. A., 2015, In : BMJ (Online). 350, p. h538

Research output: Contribution to journalArticle

Back Pain
Chronic Pain
4 Citations
Back Pain
Chronic Pain
1 Citations

Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms?

Turner, J. A., Comstock, B. A., Standaert, C. J., Heagerty, P. J., Jarvik, J. G., Deyo, R. A., Wasan, A. D., Nedeljkovic, S. S. & Friedly, J. L., Nov 1 2015, In : Spine Journal. 15, 11, p. 2319-2331 13 p.

Research output: Contribution to journalArticle

Epidural Injections
Spinal Stenosis
Lidocaine
Adrenal Cortex Hormones
Leg
66 Citations

Core outcome domains for clinical trials in non-specific low back pain

Chiarotto, A., Deyo, R. A., Terwee, C. B., Boers, M., Buchbinder, R., Corbin, T. P., Costa, L. O. P., Foster, N. E., Grotle, M., Koes, B. W., Kovacs, F. M., Lin, C. W. C., Maher, C. G., Pearson, A. M., Peul, W. C., Schoene, M. L., Turk, D. C., van Tulder, M. W. & Ostelo, R. W., Jun 4 2015, In : European Spine Journal. 24, 6, p. 1127-1142 16 p.

Research output: Contribution to journalArticle

Low Back Pain
Consensus
Clinical Trials
Quality of Life
Pain

Erratum: Report of the NIH Task Force on Research Standards for Chronic Low Back Pain (Spine Journal (2014) 14, (1375-1391))

Deyo, R. A., Dworkin, S. F., Amtmann, D. & Carrino, J. A., May 1 2015, In : Spine Journal. 15, 5, p. A14

Research output: Contribution to journalArticle

Advisory Committees
Low Back Pain
Spine
Research
2 Citations

Erratum to Core outcome domains for clinical trials in non-specific low back pain [Eur Spine J, DOI 10.1007/s00586-015-3892-3]

Chiarotto, A., Deyo, R. A., Terwee, C. B., Boers, M., Buchbinder, R., Corbin, T. P., Costa, L. O. P., Foster, N. E., Grotle, M., Koes, B. W., Kovacs, F. M., Lin, C. W. C., Maher, C. G., Pearson, A. M., Peul, W. C., Schoene, M. L., Turk, D. C., van Tulder, M. W. & Ostelo, R. W., May 8 2015, In : European Spine Journal. 24, 9, p. 2097 1 p.

Research output: Contribution to journalArticle

23 Citations

Fusion surgery for lumbar degenerative disc disease: Still more questions than answers

Deyo, R. A., Feb 1 2015, In : Spine Journal. 15, 2, p. 272-274 3 p.

Research output: Contribution to journalArticle

Total Disc Replacement
Intervertebral Disc Degeneration
Spinal Fusion
Intervertebral disc disease
5 Citations

Lumbar Imaging With Reporting Of Epidemiology (LIRE)-Protocol for a pragmatic cluster randomized trial

Jarvik, J. G., Comstock, B. A., James, K. T., Avins, A. L., Bresnahan, B. W., Deyo, R. A., Luetmer, P. H., Friedly, J. L., Meier, E. N., Cherkin, D. C., Gold, L. S., Rundell, S. D., Halabi, S. S., Kallmes, D. F., Tan, K. W., Turner, J. A., Kessler, L. G., Lavallee, D. C., Stephens, K. A. & Heagerty, P. J., Nov 1 2015, In : Contemporary Clinical Trials. 45, p. 157-163 7 p.

Research output: Contribution to journalArticle

Epidemiology
Spine
Back Pain
Incidental Findings
Primary Health Care