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Fogleman C, McKenna K. Integrative Health Strategies to Manage Chronic Pain. Prim Care 2022; 49:469-483. [DOI: 10.1016/j.pop.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Weis CA, Pohlman K, Barrett J, Clinton S, da Silva-Oolup S, Draper C, Lee J, Kumar R, O'Beirne M, Stuber K, Hawk C. Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process. J Manipulative Physiol Ther 2022; 45:469-489. [PMID: 34836673 DOI: 10.1016/j.jmpt.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 01/01/2021] [Accepted: 03/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this project was to develop a best-practices document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination. METHODS A modified Delphi consensus process was conducted. A multidisciplinary steering committee of 11 health care professionals developed 71 seed statements based on their clinical experience and relevant literature. A total of 78 panelists from 7 countries were asked to rate the recommendations (70 chiropractors and representatives from 4 other health professions). Consensus was reached when at least 80% of the panelists deemed the statement to be appropriate along with a median response of at least 7 on a 9-point scale. RESULTS Consensus was reached on 71 statements after 3 rounds of distribution. Statements included informed consent and risks, multidisciplinary care, key components regarding LBP during pregnancy, PGP during pregnancy and combined pain during pregnancy, as well as key components regarding postpartum LBP, PGP, and combined pain. Examination, diagnostic imaging, interventions, and lifestyle factors statements are included. CONCLUSION An expert panel convened to develop the first best-practice consensus document on chiropractic care for pregnant and postpartum patients with LBP or PGP. The document consists of 71 statements on chiropractic care for pregnant and postpartum patients with LBP and PGP.
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Affiliation(s)
- Carol Ann Weis
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
| | | | | | - Susan Clinton
- Embody Physiotherapy & Wellness (Private Practice), Andrews University, Sewickley, Pennsylvania
| | - Sophia da Silva-Oolup
- Undergraduate Department, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Crystal Draper
- Undergraduate Department, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Joyce Lee
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Rupali Kumar
- Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas Texas
| | - Maeve O'Beirne
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Kent Stuber
- Canadian Memorial Chiropractic College, Calgary, AB, Canada
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Schoeb V, Misteli M, Kwan C, Wong CWY, Kan MMP, Opsommer E, Wong AYL. Experiences of community-dwelling older adults with chronic low back pain in Hong Kong and Switzerland - A qualitative study. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:920387. [PMID: 36188964 PMCID: PMC9397675 DOI: 10.3389/fresc.2022.920387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022]
Abstract
Introduction The prevalence of chronic low back pain (LBP) increases with age and older adults are more vulnerable to develop chronic LBP. A recent Swiss study has shown that 78% of community-dwelling older adults aged ≥65 years experienced chronic LBP. Similarly, a study in Hong Kong found that approximately 30% of people aged above 60 years experienced chronic LBP. The aim of this collaborative research project was to illuminate older adults' experiences of living with chronic LBP and its implication on older adults' daily life in Western and Eastern cultures. Methods Twenty-five older people experiencing chronic LBP living in Switzerland or Hong Kong were recruited through health professionals or community centres. Using semi-structured interviews, participants shared their experiences regarding chronic LBP and its implications on their daily life. The interviews were recorded and transcribed "ad verbatim" in the original language. An inductive thematic analysis was used, using a qualitative data analysis software program (NVivo) and a shared code book in English. The Swiss and Hong Kong research teams engaged in collaborative analysis until a consensus was established, taking into consideration of cultural specificities. Ethical approval was obtained from the local ethic committees in both regions. Results Themes were related to negative perceptions/experiences: (1) interferences of daily function; (2) pessimistic attitudes toward their conditions/prognosis; and (3) self-perceived burden related to families. Conversely, four themes revealed attributes to social roles: (1) maintaining their roles in families; (2) experiencing supports from family and friends; (3) being content despite LBP; and (4) enjoying social activities. Cultural differences between Switzerland and Hong Kong were related to social circles and offers from the healthcare system, influencing individual experiences and perceptions. Discussion Although chronic LBP may negatively impact older adults, individual approaches as well as social and health system supports influence older adults' attitude toward their pain and self-management strategies. Developing effective and culturally sensitive interventions for an elderly population with chronic LBP can be challenging but essential for the development of innovative healthcare services tailored to the population's needs. The methodological approach used for this research project establishes the framework for developing and evaluating complex interventions.
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Affiliation(s)
- Veronika Schoeb
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Marceau Misteli
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Crystal Kwan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Chris W. Y. Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Mandy M. P. Kan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Emmanuelle Opsommer
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Arnold Y. L. Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
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Costa F, Janela D, Molinos M, Moulder R, Bento V, Lains J, Scheer J, Yanamadala V, Cohen S, Dias Correia F. Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study. J Med Internet Res 2022; 24:e38942. [PMID: 35714099 PMCID: PMC9361146 DOI: 10.2196/38942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Comorbidity between musculoskeletal (MSK) pain and depression is highly common, and is associated with a greater symptom burden and greater loss of work productivity than either condition alone. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement. OBJECTIVE The aim of this study was to assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels. METHODS Ad hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP was performed. Three subgroups with different baseline depression severity levels were established based on responses to the Patient Health Questionnaire (PHQ-9): cluster 1 (score<5: minimal depression), cluster 2 (scores 5-10: mild depression), and cluster 3 (score≥10: moderate depression). The mean changes in depression, anxiety, fear-avoidance beliefs, work productivity, and activity impairment and adherence between baseline and end of program (8-12 weeks) were assessed across subgroups by latent growth curve analysis. RESULTS From a total of 7785 eligible participants, 6137 (78.83%) were included in cluster 1, 1158 (14.87%) in cluster 2, and 490 (6.29%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not in cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (score of 5 and 10, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from -16.82, 95% CI -20.32 to -13.42 in cluster 1 to -20.10, 95% CI -32.64 to -7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74). CONCLUSIONS A multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain. TRIAL REGISTRATION ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946.
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Affiliation(s)
| | | | | | - Robert Moulder
- Institute for Cognitive Science, University of Colorado, Boulder, CO, United States
| | | | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, United States
| | - Vijay Yanamadala
- SWORD Health Inc, Draper, UT, United States
- Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States
| | - Steven Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Fernando Dias Correia
- SWORD Health Inc, Draper, UT, United States
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Pieri E, Bonetti F, Pellicciari L, Scipioni F. Well-described exercises for chronic low back pain in Life Science Literature: A systematic review. J Back Musculoskelet Rehabil 2022; 35:729-742. [PMID: 34957993 DOI: 10.3233/bmr-210179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Therapeutic exercise (TE) is recommended in multimodal treatment for patients with non-specific chronic back pain (cLBP). OBJECTIVE The aim of this study is to identify an exercise or a spectrum of exercises, well described and reproducible by the clinician, for cLBP patients. METHODS Systematic review by researching in the databases MEDLINE, EMBASE, PEDro, CINAHL, and Scopus. Evidence from Randomized Controlled Trials (RCTs) supported the TE in patients with non-specific cLBP, provided that it was well described and could be repeated by another therapist. Methodological evaluation was performed using the PEDro scale and only studies with a score of ⩾ 6 were included. The assessment of the intervention description was carried out with the TIDieR checklist. The risk of bias was examined. RESULTS Twenty-one articles were included in this systematic review. The defective description and the poorly reporting of the intervention makes it more difficult for the clinician to include the TE into clinical practice. CONCLUSIONS The findings of this study showed that the reporting of the intervention in high quality RCT on chronic low back pain is low, threatening the external validity of the results.
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Affiliation(s)
| | - Francesca Bonetti
- University of Rome Tor Vergata, Rome, Italy.,Physioup - Physiotherapy Practice, Rome Italy
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Li Z, Ye D, Dai L, Xu Y, Wu H, Luo W, Liu Y, Yao X, Wang P, Miao H, Xu J, Liang W. Single-Cell RNA Sequencing Reveals the Difference in Human Normal and Degenerative Nucleus Pulposus Tissue Profiles and Cellular Interactions. Front Cell Dev Biol 2022; 10:910626. [PMID: 35874809 PMCID: PMC9301035 DOI: 10.3389/fcell.2022.910626] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background: The nucleus pulposus is a constituent structure of the human intervertebral disc, and its degeneration can cause intervertebral disc degeneration (IDD). However, the cellular and molecular mechanisms involved remain elusive. Methods: Through bioinformatics analysis, the single-cell transcriptome sequencing expression profiles of human normal nucleus pulposus (NNP) cells and human degenerative nucleus pulposus (DNP) cells were compared to clarify the transcriptome differential expression profiles of human NNP and DNP. The single-cell sequencing results of the two samples were analyzed using bioinformatics methods to compare the differences in histiocytosis between human NNP and DNP, map the histiocytes of NNP and DNP, perform cell differentiation trajectories for the cell populations of interest and predict cell function, and explore their heterogeneity by pathway analysis and Gene Ontology analysis. Results: Nine cell types were identified, which were chondrocyte 1, chondrocyte 2, chondrocyte 3, chondrocyte 4, chondrocyte 5, endothelial, macrophage, neutrophil, and T cells. Analysis of the proportion of chondrocytes in different tissues revealed that chondrocyte 1 accounted for a higher proportion of NNP cells and highly expressed COL2A1 compared with DNP cells; chondrocyte 2, chondrocyte 3, chondrocyte 4, and chondrocyte 5 accounted for a higher proportion of DNP cells compared with NNP cells. Among them, chondrocyte 2 was an inhibitory calcified chondrocyte with high expression of MGP, chondrocytes 3 were fibrochondrocytes with high expression of COL1A1, chondrocytes 4 were chondrocytes that highly express pain inflammatory genes such as PTGES, and chondrocytes 5 were calcified chondrocytes with high expression of FN1 (chondrocytes 4 and chondrocytes 5 were found for the first time in a study of single-cell transcriptome sequencing of disc tissue). Cell trajectory analysis revealed that chondrocyte 1 was at the beginning of the trajectory and chondrocyte 3 was at the end of the trajectory, while chondrocyte 5 appeared first in the trajectory relative to chondrocyte 2 and chondrocyte 4. Conclusion: After functional identification of the specifically expressed genes in five chondrocytes, it was found that chondrocyte 1 was a chondrocyte with high expression of COL2A1, COL9A2, COL11A2, and CHRDL2 in a high proportion of NNP cells, and chondrocyte 3 was a fibrochondrocyte with high expression of COL1A1, COL6A3, COL1A2, COL3A1, AQP1, and COL15A1 in an increased proportion during nucleus pulposus cell degeneration. Through cell trajectory analysis, it was found that chondrocytes 5 specifically expressing FN1, SESN2, and GDF15 may be the key cells leading to degeneration of nucleus pulposus cells. Chondrocytes 2 expressing MGP, MT1G, and GPX3 may play a role in reversing calcification and degeneration, and chondrocytes 4 expressing PTGES, TREM1, and TIMP1 may play a role in disc degeneration pain and inflammation.
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Affiliation(s)
- Zhencong Li
- Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Dongping Ye
- Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China,*Correspondence: Dongping Ye, ; Haixiong Miao, ; Jiake Xu, ; Weiguo Liang,
| | - Libing Dai
- Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Yude Xu
- Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Hao Wu
- Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Wei Luo
- Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Yiming Liu
- Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Xiguan Yao
- Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Peigeng Wang
- Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Haixiong Miao
- Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China,*Correspondence: Dongping Ye, ; Haixiong Miao, ; Jiake Xu, ; Weiguo Liang,
| | - Jiake Xu
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia,*Correspondence: Dongping Ye, ; Haixiong Miao, ; Jiake Xu, ; Weiguo Liang,
| | - Weiguo Liang
- Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China,*Correspondence: Dongping Ye, ; Haixiong Miao, ; Jiake Xu, ; Weiguo Liang,
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Huang F, Xiao Z, Zhan X, Zeng P, Zhao S, Guo R, Tian Q, Fan Z, Wu S. Tuina combined with Adjuvant therapy for lumbar disc herniation: A network meta-analysis. Complement Ther Clin Pract 2022; 49:101627. [PMID: 35849972 DOI: 10.1016/j.ctcp.2022.101627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/16/2022] [Accepted: 06/26/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To directly or indirectly compare the effectiveness and pain relief of TN combined with different treatments for lumbar disc herniation (LDH). METHODS The Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), Wanfang data, Chinese Biomedical Literature database (CBM), Chinese Scientific Journal Database (VIP), PubMed, Embase, Cochrane library, and Web of Science were searched from inception to July 2020. Only full texts of randomized controlled trials (RCTs) that make comparisons between Tuina and Tuina combined with other methods were included. We extracted trial data and assessed the risk of bias by two reviewers independently. We pooled continuous data in standard mean differences (SMDs) and binary data in risk ratios (RRs), and provided 95% confidence intervals. The primary outcomes were the effectiveness rate. The secondary outcome was pain measurements including visual analog scale (VAS) scores. RESULTS Forty-four trials which included 4741 participants and 16 kinds of interventions were selected in our study. Tuina combined with Acupuncture was the most frequently investigated intervention. Five (31%) kindnesces (SMDs) and binary data in risk ratios (RRs), and provided 95% confidence intervals. The primary outcomes were the effectiveness rate. The secondary outcome was pain measurements including visual analog scale (VAS) scores. RESULTS Forty-four trials of treatments among 15 increased the healing rate more significantly compared with Tuina(TN), including Tuian combined with Traction and formula(TN + TRA + FM), Tuina combined with formula(TN + FM), Tuina combined with Traction and Acupuncture(ACU + TN + TRA), Tuian combined with Traction(TN + TRA), Tuina combined with Electroacupuncture(EA + TN), Tuina combined with the warm needle(TN + WN), Tuina combined with Acupuncture(ACU + TN). Seven treatments including Tuina combined with Electroacupuncture(EA + TN), Tuian combined with Traction and formula(TN + TRA + FM), Tuina combined with Acupuncture(ACU + TN), Tuina combined with formula(TN + FM), Acupuncture(ACU), Tuian combined with Traction(TN + TRA), Tuina combined with the warm needle(TN + WN) had better effects in reducing pain intensity compared with Tuina, range from 0.01 (95%Crl 0-0.08) for EA + TN to 0.30 (95%Crl 0.20-0.45) for TN + WN. CONCLUSIONS According to the comprehensive review, Tuina combined with Traction and formula(TN + TRA + FM) seemed to be the most recommendable treatment which is more affordable and effective. However, all the available evidence was of low quality, so more high-quality studies are expected to confirm the effectiveness. REGISTRATION NUMBER PROSPERO CRD42020193068.
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Affiliation(s)
- Fan Huang
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Zhaoxun Xiao
- Department of Anatomy and Histology & Embryology, Faculty of Basic Medical Science, Kunming Medical University, 1168 West Chunrong Road, Kunming, 650500, Yunnan, China
| | - Xiaoxuan Zhan
- Department of Rehabilitation Medicine, Affiliated Haikou Hospital of Central South University Xiangya School of Medicine, Haikou, 570208, Hainan, China
| | - Ping Zeng
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Siyi Zhao
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Rusong Guo
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Qiang Tian
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Zhiyong Fan
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
| | - Shan Wu
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
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Gianola S, Bargeri S, Cinquini M, Iannicelli V, Meroni R, Castellini G. More than one third of clinical practice guidelines on low back pain overlap in AGREE II appraisals. Research wasted? BMC Med Res Methodol 2022; 22:184. [PMID: 35790902 PMCID: PMC9254584 DOI: 10.1186/s12874-022-01621-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Systematic reviews can apply the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool to critically appraise clinical practice guidelines (CPGs) for treating low back pain (LBP); however, when appraisals differ in CPG quality rating, stakeholders, clinicians, and policy-makers will find it difficult to discern a unique judgement of CPG quality. We wanted to determine the proportion of overlapping CPGs for LBP in appraisals that applied AGREE II. We also compared inter-rater reliability and variability across appraisals. METHODS For this meta-epidemiological study we searched six databases for appraisals of CPGs for LBP. The general characteristics of the appraisals were collected; the unit of analysis was the CPG evaluated in each appraisal. The inter-rater reliability and the variability of AGREE II domain scores for overall assessment were measured using the intraclass correlation coefficient and descriptive statistics. RESULTS Overall, 43 CPGs out of 106 (40.6%) overlapped in seventeen appraisals. Half of the appraisals (53%) reported a protocol registration. Reporting of AGREE II assessment was heterogeneous and generally of poor quality: overall assessment 1 (overall CPG quality) was rated in 11 appraisals (64.7%) and overall assessment 2 (recommendation for use) in four (23.5%). Inter-rater reliability was substantial/perfect in 78.3% of overlapping CPGs. The domains with most variability were Domain 6 (mean interquartile range [IQR] 38.6), Domain 5 (mean IQR 28.9), and Domain 2 (mean IQR 27.7). CONCLUSIONS More than one third of CPGs for LBP have been re-appraised in the last six years with CPGs quality confirmed in most assessments. Our findings suggest that before conducting a new appraisal, researchers should check systematic review registers for existing appraisals. Clinicians need to rely on updated CPGs of high quality and confirmed by perfect agreement in multiple appraisals. TRIAL REGISTRATION Protocol Registration OSF: https://osf.io/rz7nh/.
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Affiliation(s)
- Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Via R.Galeazzi 4, 20162, Milan, Italy.
| | - Silvia Bargeri
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Via R.Galeazzi 4, 20162, Milan, Italy
| | - Michela Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Roberto Meroni
- Department of Physiotherapy, LUNEX International University of Health, Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute, Differdange, Luxembourg
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Via R.Galeazzi 4, 20162, Milan, Italy
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Lardon A, Pagé I, Nougarou F, Descarreaux M. Neuromechanical Responses to Spinal Manipulation and Mobilization: A Crossover Randomized Clinical Trial. J Manipulative Physiol Ther 2022; 45:1-8. [PMID: 35753884 DOI: 10.1016/j.jmpt.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/06/2021] [Accepted: 03/17/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the immediate effect of spinal manipulation (SMa) and spinal mobilization (SMo) on muscular responses, spinal stiffness, and segmental spinal pressure evoked pain in a population of participants with chronic middle back pain (MBP). METHODS In a crossover randomized trial, 2 experienced chiropractors assessed whether volunteers were eligible for the protocol according to a list of specific inclusion and exclusion criteria. Individuals with MBP participated in 2 experimental sessions within 72 hours. During the first session, participants randomly received a SMa or SMo delivered by an apparatus using a servolinear motor. During the second session, the other modality was delivered. Spinal stiffness and pressure-provoked pain intensity outcomes were assessed before and after each therapy, and muscular responses were recorded during the treatment using surface electromyographic sensors. Signed-rank Wilcoxon tests for muscular responses and generalized model for repeated measure for spinal stiffness and pressure-provoked pain were used for statistical analyses. RESULTS Among the 32 potential participants, 26 (mean age 29.9 [±9.14], 15 women) completed both sessions. Between-group differences were observed for the muscular response amplitude (P < .001), and indeed the normalized RMS muscular response was found to be higher during SMa than SMo. Similar results were observed for pressure-provoked pain intensity at the level of therapeutic modality application (P = .002) as a higher decrease in pain was found after SMa (47.9 [±22.8] to 36.6 [±23.7]) compared with SMo (47.2 [±23.2] to 45.5 [±24.3]). No between-group differences were found for spinal stiffness change, nor for terminal (P = .08) and global spinal stiffness (P = .06). CONCLUSION In a controlled environment, spinal manipulation and mobilization generated different muscle responses and had different immediate effects on pressure-provoked pain intensity for subjects with MBP.
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Affiliation(s)
- Arnaud Lardon
- Department of Human Kinetics, University of Québec, Trois-Rivières, Québec, Canada; Franco-European Institute of Chiropractic, Ivry-sur Seine, France.
| | - Isabelle Pagé
- Department of Human Kinetics, University of Québec, Trois-Rivières, Québec, Canada
| | - François Nougarou
- Department of Electrical Engineering, University of Québec, Trois-Rivières, Québec, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, University of Québec, Trois-Rivières, Québec, Canada
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An update of current therapeutic approach for Intervertebral Disc Degeneration: A review article. Ann Med Surg (Lond) 2022; 77:103619. [PMID: 35638079 PMCID: PMC9142636 DOI: 10.1016/j.amsu.2022.103619] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 01/09/2023] Open
Abstract
Intervertebral disc degeneration is a natural process of aging. It can cause physical, psychological, and socioeconomic impact due to the decreasing function of the spine and pain manifestation. Conservative and surgical treatment to correct symptoms and structural anomalies does not fully recover the degenerated disc. Several therapeutic approaches have been developed to improve the clinical result and patient's quality of life. This paper aims to review previous studies that discussed potential novel approach in order to make effective degenerated disc restoration. We tried to briefly describe IVD, IDD, also review several promising current therapeutic approaches for degenerated disc treatment, including its relevance to the degeneration process and limitation to be applied in a clinical setting. There are generally four current therapeutic approaches that we reviewed; growth factors, small molecules, gene therapy, and stem cells. These new approaches aim to not only correct the symptoms but also restore and delay the degeneration process. Intervertebral Disc Degeneration. Current Therapeutic Approach. Stem Cell Therapy.
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Gevers-Montoro C, Romero-Santiago M, Losapio L, Conesa-Buendía FM, Newell D, Álvarez-Galovich L, Piché M, Ortega-De Mues A. Presence of Tumor Necrosis Factor-Alpha in Urine Samples of Patients With Chronic Low Back Pain Undergoing Chiropractic Care: Preliminary Findings From a Prospective Cohort Study. Front Integr Neurosci 2022; 16:879083. [PMID: 35492573 PMCID: PMC9039288 DOI: 10.3389/fnint.2022.879083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aims Low back pain is the leading cause of years lived with disability worldwide. Chiropractors employ different interventions to treat low back pain, including spinal manipulative therapy, although the mechanisms through which chiropractic care improves low back pain are still unclear. Clinical research and animal models suggest that spinal manipulation might modulate plasma levels of inflammatory cytokines, which have been involved in different stages of low back pain. More specifically, serum levels of Tumor Necrosis Factor-alpha (TNF-α) have been found to be elevated in patients with chronic low back pain. We aimed to investigate whether urine from chronic low back pain patients could be an appropriate medium to measure concentrations of TNF-α and to examine possible changes in its levels associated to chiropractic care. Methods Urine samples were collected from 24 patients with chronic low back pain and TNF-α levels were analyzed by ELISA before and after 4-6 weeks of care compared to a reference value obtained from 5 healthy control subjects, by means of a Welch's t-test. Simultaneously, pain intensity and disability were also evaluated before and after care. Paired t-tests were used to compare mean pre and post urinary concentrations of TNF-α and clinical outcomes. Results Significantly higher baseline levels of urinary TNF-α were observed in chronic low back pain patients when compared to our reference value (p < 0.001), which were significantly lower after the period of chiropractic treatment (p = 0.03). Moreover, these changes were accompanied by a significant reduction in pain and disability (both p < 0.001). However, levels of urinary TNF-α were not correlated with pain intensity nor disability. Conclusion These results suggest that urine could be a good milieu to assess TNF-α changes, with potential clinical implications for the management of chronic low back pain.
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Affiliation(s)
- Carlos Gevers-Montoro
- Madrid College of Chiropractic – RCU María Cristina, Madrid, Spain
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | - Lisa Losapio
- Madrid College of Chiropractic – RCU María Cristina, Madrid, Spain
| | | | - Dave Newell
- Chiropractic Department, AECC University College, Bournemouth, United Kingdom
| | | | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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62
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Wong JJ, Tricco AC, Côté P, Liang CY, Lewis JA, Bouck Z, Rosella LC. Association Between Depressive Symptoms or Depression and Health Outcomes for Low Back Pain: a Systematic Review and Meta-analysis. J Gen Intern Med 2022; 37:1233-1246. [PMID: 34383230 PMCID: PMC8971223 DOI: 10.1007/s11606-021-07079-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Study results vary on whether depressive symptoms are associated with worse prognosis for low back pain (LBP). We assessed the association between depressive symptoms or depression and health outcomes in persons with LBP. METHODS We searched MEDLINE, Embase, CINAHL, and PsycINFO from inception to June 2020. Eligible studies were cohort and case-control studies assessing the association between depressive symptoms (questionnaires) or depression (diagnoses) and health outcomes in persons aged ≥16 years with LBP in the absence of major pathology. Reviewers independently screened articles, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. We classified exploratory versus confirmatory studies based on phases of prognostic factor investigation. We conducted random-effects meta-analyses and descriptive synthesis where appropriate. RESULTS Of 13,221 citations screened, we included 62 studies (63,326 participants; 61 exploratory studies, 1 confirmatory study). For acute LBP, depressive symptoms were associated with self-reported disability (descriptive synthesis: 6 studies), worse recovery (descriptive synthesis: 5 studies), and slower traffic injury-related claim closure (1 study), but not pain or work-related outcomes. Depressive symptoms were associated with greater primary healthcare utilization for acute LBP (1 confirmatory study). For chronic LBP, depressive symptoms were associated with higher pain intensity (descriptive synthesis: 9 studies; meta-analysis: 3 studies, 2902 participants, β=0.11, 95% confidence interval (CI) 0.05-0.17), disability (descriptive synthesis: 6 studies; meta-analysis: 5 studies, 3549 participants, β=0.16, 95% CI 0.04-0.29), and worse recovery (descriptive synthesis: 2 studies; meta-analysis: 2 studies, 13,263 participants, relative risk (RR)=0.91, 95% CI 0.88-0.95), but not incident chronic widespread pain (1 study). DISCUSSION Depressive symptoms may be associated with self-reported disability and worse recovery in persons with acute and chronic LBP, and greater primary healthcare utilization for acute LBP. Our review provides high-quality prognostic factor information for LBP. Healthcare delivery that addresses depressive symptoms may improve disability and recovery in persons with LBP. Confirmatory studies are needed to assess the association between depressive symptoms and health outcomes in persons with LBP. PROTOCOL REGISTRATION PROSPERO database (CRD42019130047).
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Affiliation(s)
- Jessica J Wong
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada. .,Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada.
| | - Andrea C Tricco
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Room 716, Toronto, Ontario, M5B 1W8, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, Ontario, M5B 1T8, Canada
| | - Pierre Côté
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada.,Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, Ontario, M5B 1T8, Canada.,Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, Ontario, L1H 7K4, Canada
| | - Catherine Y Liang
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - Jeremy A Lewis
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada
| | - Zachary Bouck
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada.,Centre for Drug Policy and Evaluation, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Laura C Rosella
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, M5T 3M7, Canada.,ICES, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.,Stephen Family Chair in Community Health, Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, Ontario, L5B 1B8, Canada
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63
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Oliveira IS, Tomazoni SS, Vanin AA, Araujo AC, de Medeiros FC, Oshima RKA, Costa LOP, Costa LDCM. Management of acute low back pain in emergency departments in São Paulo, Brazil: a descriptive, cross-sectional analysis of baseline data from a prospective cohort study. BMJ Open 2022; 12:e059605. [PMID: 35365544 PMCID: PMC8977796 DOI: 10.1136/bmjopen-2021-059605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe management strategies used in public emergency departments in a middle-income country for patients with acute non-specific low back pain. DESIGN A descriptive, cross-sectional analysis of baseline data from a prospective cohort study. SETTING AND PARTICIPANTS A study with 600 patients with low back pain presenting in four public emergency departments from São Paulo, Brazil was conducted. OUTCOME MEASURES Diagnostic tests, pharmacological interventions, and/or referral to other healthcare professionals were collected. Descriptive analyses were used to report all outcomes. RESULTS Of all patients, 12.5% (n=75) underwent some diagnostic imaging tests. Medication was administered to 94.7% (n=568) of patients. The most common medications were non-steroidal anti-inflammatory drugs (71.3%; n=428), opioids (29%; n=174) and corticosteroids (22.5%; n=135). Only 7.5% (n=45) of patients were referred to another type of care. CONCLUSION There is a need for research data on low back pain from middle-income countries. There was an acceptable rate of prescription for diagnostic imaging tests. However, there were high medication prescriptions and small rates of referrals to other healthcare services. Our findings indicate that there is still a need to implement best practices in the management of acute low back pain at public emergency departments in Brazil.
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Affiliation(s)
- Indiara Soares Oliveira
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Shaiane Silva Tomazoni
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Adriane Aver Vanin
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Amanda Costa Araujo
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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Meng Z, Zheng J, Fu K, Kang Y, Wang L. Curative Effect of Foraminal Endoscopic Surgery and Efficacy of the Wearable Lumbar Spine Protection Equipment in the Treatment of Lumbar Disc Herniation. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6463863. [PMID: 35368945 PMCID: PMC8975632 DOI: 10.1155/2022/6463863] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 11/21/2022]
Abstract
Lumbar disc herniation is a common and frequently-occurring disease in pain clinics. The incidence rate of affliction is increasing with every passing year. Besides the aged, young people also suffer from long-term pain, which not only affects their daily routines but may also lead to serious impairment. The causes of chronic low back and leg pain caused by lumbar disc herniation are mainly related to mechanical compression, the adhesion of epidural space, intervertebral space, and aseptic inflammatory reaction. The treatment of lumbar disc herniation should follow the principle of step-by-step treatment. An appropriate treatment scheme needs to be adopted according to the patient's condition. About 80% of patients received nonsurgical treatment to get relief from the pain symptoms. However, 10% to 15% of patients still need traditional open surgery. Spinal foraminal surgery is a new method for the treatment of lumbar disc herniation, lumbar surgery failure syndrome, and lumbar spinal stenosis. However, there are only scattered clinical reports on the efficacy of spinal foraminal surgery. Based on it, this paper proposes a method to explore the efficacy of spinal foraminal mirror surgery in the treatment of lumbar disc herniation. Besides, postoperative wearable lumbar protective equipment is proposed to ensure a seamless rehabilitation effect on the patients. Statistical analysis performed using a t-test revealed that there was a significant difference between the visual analog scales (VAS) scores of the two groups after 3 and 6 months of treatment (P < 0.05). The paper analyzes and summarizes the cases with definite and poor curative effects, which not only provides the basis for clinical practice but also paves the way to multicenter clinical research.
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Affiliation(s)
- ZhaoWu Meng
- Sunshine Union Hospitai,Spinal Surgery, Weifang, Shandong 261000, China
| | - JinYang Zheng
- Sunshine Union Hospitai,Spinal Surgery, Weifang, Shandong 261000, China
| | - Kai Fu
- Sunshine Union Hospitai,Spinal Surgery, Weifang, Shandong 261000, China
| | - YiZhao Kang
- Sunshine Union Hospitai,Spinal Surgery, Weifang, Shandong 261000, China
| | - Liang Wang
- Sunshine Union Hospitai,Spinal Surgery, Weifang, Shandong 261000, China
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Mailloux C, Wideman TH, Massé-Alarie H. Wrist, but Not Back, Isometric Contraction Induced Widespread Hypoalgesia in Healthy Participants. FRONTIERS IN PAIN RESEARCH 2022; 2:701830. [PMID: 35295510 PMCID: PMC8915648 DOI: 10.3389/fpain.2021.701830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/12/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: Exercise may reduce pain sensitivity. This phenomenon called exercise-induced hypoalgesia is observed in different types of exercises and involves the activation of endogenous pain modulation systems. Although the effect of limb exercise on pain sensitivity has often been tested, few studies explored the impact of back exercises that are often used to treat low back pain. The main objective is to measure the effect of back-muscle exercise on pain sensitivity and compare it to the effect of a limb-muscle exercise. Methods: Twenty-three participants who were pain-free performed a 4-min wrist flexion isometric contraction followed by a 4-min low back extension, separated by a 20-min break. Pressure pain thresholds were tested at two low back (S1 spinous process, lumbar erector spinae muscle) and two wrist (capitate bone, wrist flexor muscles) sites before and after each exercise. For each exercise, sites were considered as remote or local in relation to the muscles contracted during the exercise. An independent sample of 11 participants was recruited to confirm the influence of low back extension on pain sensitivity. Results: Wrist exercise induced a larger increase in pain sensitivity than back exercise at the remote site. Only wrist exercise induced a hypoalgesia effect at both the local and the remote sites. Back exercise induced a similar effect in the independent sample. Conclusions: This study showed that back and wrist exercises induced a distinct effect on pain sensitivity in participants who were pain-free. The wrist exercise induced a systemic reduction in pain sensitivity (locally and remotely), whereas the back exercise did not. This differential effect may be present because wrist exercise induced most fatigue compared with the back exercise.
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Affiliation(s)
- Catherine Mailloux
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Quebec City, QC, Canada
| | - Timothy H Wideman
- Lethbridge-Layton-Mackay Rehabilitation Centre, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Hugo Massé-Alarie
- Département de réadaptation, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Quebec City, QC, Canada
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Hayashi K, Miki K, Kajiyama H, Ikemoto T, Yukioka M. Impact of Non-steroidal Anti-inflammatory Drug Administration for 12 Months on Renal Function. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 2:644391. [PMID: 35295466 PMCID: PMC8915618 DOI: 10.3389/fpain.2021.644391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/13/2021] [Indexed: 11/13/2022]
Abstract
Background: The use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of renal complications. Resolution of renal adverse effects after NSAID administration has been observed after short-term use. Thus, the present study aimed to investigate a series of patients with chronic musculoskeletal pain who underwent long-term NSAID administration followed by switching to tramadol hydrochloride/acetaminophen (TA) combination tablets to study the impact of NSAID-induced renal adverse effects. Methods: This was a longitudinal retrospective study of 99 patients with chronic musculoskeletal pain. The patients were administrated with NSAIDs daily during the first 12 months, followed by daily TA combination tablets for 12 months. Estimated glomerular filtration rate (eGFR) and serum levels of aspartate aminotransferase and alanine transaminase were measured at baseline, after NSAID administration and after TA administration. Results: eGFR was significantly reduced after 12-month NSAID administration (median, from 84.0 to 72.8 ml/min/1.73 m2), and the reduction was not shown after the subsequent 12-month TA administration (median, 71.5 ml/min/1.73 m2). Reduction in eGFR was less in patients who received celecoxib (median, -1.8 ml/min/1.73 m2) during the first 12 months. There was no significant difference in aspartate aminotransferase and alanine transaminase in each period. Conclusions: Thus, patients receiving NSAIDs for 12 months displayed both reversible and irreversible reduction of eGFR upon cessation of NSAIDs and switching to TA. Our data highlight the potential safety benefit of utilizing multimodal analgesic therapies to minimize the chronic administration of NSAIDs.
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Affiliation(s)
- Kazuhiro Hayashi
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Kenji Miki
- Center for Pain Management, Hayaishi Hospital, Osaka, Japan.,Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Hiroshi Kajiyama
- Department of Rheumatology and Applied Immunology, Saitama Medical University, Saitama, Japan
| | - Tatsunori Ikemoto
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Japan
| | - Masao Yukioka
- Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
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Sitges C, Terrasa JL, García-Dopico N, Segur-Ferrer J, Velasco-Roldán O, Crespí-Palmer J, González-Roldán AM, Montoya P. An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial. JMIR Mhealth Uhealth 2022; 10:e29171. [PMID: 35289758 PMCID: PMC8965676 DOI: 10.2196/29171] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/28/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Concomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions.
Objective
The aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality.
Methods
A 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46%; mean age 45.00, SD 9.13 years; 10/23, 43% men) or a face-to-face group (27/50, 54%; mean age 48.63, SD 7.54 years; 7/27, 26% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times).
Results
After the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; P<.001), helplessness (6.38 vs 4.74; P=.02), fear-avoidance beliefs (35 vs 29.11; P=.03), and avoidance of physical activity (12.07 vs 9.28; P=.01) scores, but there was an increase in the disability score (6.08 vs 7.5; P=.01). No significant differences between the groups or sessions were found in heart rate variability resting-state data, electroencephalographic data from the Eriksen flanker task, PPTs, subjective ratings, or cognitive performance.
Conclusions
Both intervention modalities increased mainly beta activity at rest and improved psychological functioning. Given the limitations of our study, conclusions must be drawn carefully and further research will be needed. Nevertheless, to the best of our knowledge, this is the first study reporting electroencephalographic changes in patients with CLBP after an mHealth intervention.
Trial Registration
ClinicalTrials.gov NCT04576611; https://clinicaltrials.gov/ct2/show/NCT04576611
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Affiliation(s)
- Carolina Sitges
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Juan L Terrasa
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Nuria García-Dopico
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain
| | - Joan Segur-Ferrer
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Olga Velasco-Roldán
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain
| | - Jaume Crespí-Palmer
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Ana María González-Roldán
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Pedro Montoya
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
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Koppenaal T, Pisters MF, Kloek CJ, Arensman RM, Ostelo RW, Veenhof C. The 3-Month Effectiveness of a Stratified Blended Physiotherapy Intervention in Patients With Nonspecific Low Back Pain: Cluster Randomized Controlled Trial. J Med Internet Res 2022; 24:e31675. [PMID: 35212635 PMCID: PMC8917429 DOI: 10.2196/31675] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 12/29/2022] Open
Abstract
Background Patient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning. Objective This study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP. Methods The study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ≥18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients’ risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up. Results Both the stratified blended physiotherapy group (104/208, 50%) and the face-to-face physiotherapy group (104/208, 50%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference −1.96, 95% CI −4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference −16.39, 95% CI −27.98 to −4.79) and several secondary outcomes. Conclusions The stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy. Trial Registration ISRCTN Registry 94074203; https://doi.org/10.1186/ISRCTN94074203 International Registered Report Identifier (IRRID) RR2-https://doi.org/10.1186/s12891-020-3174-z
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Affiliation(s)
- Tjarco Koppenaal
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands.,Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Martijn F Pisters
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands.,Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Corelien Jj Kloek
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands.,Research Group Innovation of Human Movement Care, Research Center Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, Netherlands
| | - Remco M Arensman
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands.,Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Raymond Wjg Ostelo
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences research institute Amsterdam, Amsterdam, Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Location VUmc, Amsterdam, Netherlands
| | - Cindy Veenhof
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands.,Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands.,Research Group Innovation of Human Movement Care, Research Center Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, Netherlands
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The Roles of circRNAs in Intervertebral Disc Degeneration: Inflammation, Extracellular Matrix Metabolism, and Apoptosis. Anal Cell Pathol (Amst) 2022; 2022:9550499. [PMID: 35186669 PMCID: PMC8856834 DOI: 10.1155/2022/9550499] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/19/2022] [Indexed: 12/15/2022] Open
Abstract
Low back pain (LBP) is seriously harmful to human health and produces heavy economic burden. And most scholars hold that intervertebral disc degeneration (IDD) is the primary cause of LBP. With the study of IDD, aberrant expression of gene has become an important pathogenic factor of IDD. Circular RNAs (circRNAs), as a kind of noncoding RNA (ncRNA), participate in the regulation of genetic transcription and translation and further affect the expression of inflammatory cytokine, metabolism of extracellular matrix (ECM), the proliferation and apoptosis of cells, etc. Therefore, maybe it will become a new therapeutic target for IDD. At present, our understanding of the mechanism of circRNAs in IDD is limited. The purpose of this review is to summarize the mechanism and related signaling pathways of circRNAs in IDD reported in the past. Particularly, the roles of circRNAs in inflammation, ECM metabolism, and apoptosis are emphasized.
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Horwitz J, Mardiros L, Musa A, Welch VA, Hodgson A, Narvey M, Ghazzawi A, Shea B, Saginur M. Scoping review of evidence for managing postnatal hypoglycaemia. BMJ Open 2022; 12:e053047. [PMID: 35135768 PMCID: PMC8830267 DOI: 10.1136/bmjopen-2021-053047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To identify what is known empirically about the screening, treatment and harm of exposure to neonatal hypoglycaemia. DESIGN Scoping review that applied a preregistered protocol based on established frameworks. DATA SOURCES Medline and Embase, up to 12 May 2020. STUDY SELECTION Comparative and case-series studies, as well as guidelines, published in English or French, on the topic of immediate inpatient postnatal glucose screening in newborns. DATA GATHERING Article selection and characterisation were performed in duplicate using predefined data extraction forms specific to primary studies and guidelines. RESULTS 12 guidelines and 74 primary studies were included. A neurodevelopmental outcome was primary in 32 studies: 30 observational studies followed up posthypoglycaemic, and the 2 intervention studies included 1 randomised controlled trial (RCT) about treatment thresholds. Three other RCTs assessed dextrose gel (two) and oral sucrose (one). 12 of 30 studies that evaluated non-neurodevelopmental primary outcomes were intervention studies. Only one cohort study compared outcomes in screened vs unscreened newborns. The guidelines did not arrive at a consensus definition of postnatal hypoglycaemic, and addressed potential harms of screening more often than primary studies. CONCLUSIONS The primary literature that informs hypoglycaemia screening is a series of studies that relate neurodevelopmental outcomes to postnatal hypoglycaemia. Further research is needed to better define an optimal threshold for hypoglycaemia that warrants intervention, based on long-term neurodevelopmental outcomes and a better delineation of potential screening harms.
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Affiliation(s)
- Jennifer Horwitz
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda Mardiros
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ahmed Musa
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Vivian A Welch
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michael Narvey
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrea Ghazzawi
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Beverley Shea
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Saginur
- Montfort Hospital, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Bilterys T, Kregel J, Nijs J, Meeus M, Danneels L, Cagnie B, Van Looveren E, Malfliet A. Influence of education level on the effectiveness of pain neuroscience education: A secondary analysis of a randomized controlled trial. Musculoskelet Sci Pract 2022; 57:102494. [PMID: 34953290 DOI: 10.1016/j.msksp.2021.102494] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Current evidence supports the use of pain neuroscience education (PNE) in several chronic pain populations. However, the effects of PNE at group level are rather small and little is known about the influence of personal factors (e.g. level of education [LoE]). OBJECTIVE To examine whether the effectiveness of PNE differs in chronic spinal pain (CSP) patients with high LOE (at least a Bachelor's degree) versus lower educated patients. METHOD A total of 120 Belgian CSP patients were randomly assigned to the experimental (PNE) or control group (biomedical-focused neck/back school). Participants within each group were further subcategorized based on highest achieved LoE. ANOVA and Bonferroni post-hoc analyses were used to evaluate differences in effectiveness of the interventions between higher and lower educated participants. RESULTS No differences between higher and lower educated participants were identified for pain-related disability. Significant interactions (P < .05) were found for kinesiophobia and several illness perceptions components. Bonferroni post-hoc analysis revealed a significant improvement in kinesiophobia (P < .001 and P < .002, medium effect sizes) and perceived negative consequences (P < .001 and P < .008, small effect sizes) in the PNE groups. Only the higher education PNE group showed a significant improvement in perceived illness cyclicity (P = .003, small effect size). Post-treatment kinesiophobia was significant lower in the higher educated PNE group compared to the higher educated control group (p < .001). CONCLUSION Overall, the exploratory findings suggest no clinical meaningful differences in effectiveness of PNE between higher and lower educated people. PNE is effective in improving kinesiophobia and several aspects of illness perceptions regardless of LoE.
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Affiliation(s)
- Thomas Bilterys
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Jeroen Kregel
- Pain in Motion International Research Group, Belgium(1); Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group, Belgium(1); Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Eveline Van Looveren
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Anneleen Malfliet
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium.
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Svendsen MJ, Sandal LF, Kjær P, Nicholl BI, Cooper K, Mair F, Hartvigsen J, Stochkendahl MJ, Søgaard K, Mork PJ, Rasmussen C. Using Intervention Mapping to Develop a Decision Support System–Based Smartphone App (selfBACK) to Support Self-management of Nonspecific Low Back Pain: Development and Usability Study. J Med Internet Res 2022; 24:e26555. [PMID: 35072645 PMCID: PMC8822424 DOI: 10.2196/26555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/07/2021] [Accepted: 11/04/2021] [Indexed: 12/29/2022] Open
Abstract
Background
International guidelines consistently endorse the promotion of self-management for people with low back pain (LBP); however, implementation of these guidelines remains a challenge. Digital health interventions, such as those that can be provided by smartphone apps, have been proposed as a promising mode of supporting self-management in people with chronic conditions, including LBP. However, the evidence base for digital health interventions to support self-management of LBP is weak, and detailed descriptions and documentation of the interventions are lacking. Structured intervention mapping (IM) constitutes a 6-step process that can be used to guide the development of complex interventions.
Objective
The aim of this paper is to describe the IM process for designing and creating an app-based intervention designed to support self-management of nonspecific LBP to reduce pain-related disability.
Methods
The first 5 steps of the IM process were systematically applied. The core processes included literature reviews, brainstorming and group discussions, and the inclusion of stakeholders and representatives from the target population. Over a period of >2 years, the intervention content and the technical features of delivery were created, tested, and revised through user tests, feasibility studies, and a pilot study.
Results
A behavioral outcome was identified as a proxy for reaching the overall program goal, that is, increased use of evidence-based self-management strategies. Physical exercises, education, and physical activity were the main components of the self-management intervention and were designed and produced to be delivered via a smartphone app. All intervention content was theoretically underpinned by the behavior change theory and the normalization process theory.
Conclusions
We describe a detailed example of the application of the IM approach for the development of a theory-driven, complex, and digital intervention designed to support self-management of LBP. This description provides transparency in the developmental process of the intervention and can be a possible blueprint for designing and creating future digital health interventions for self-management.
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Affiliation(s)
- Malene Jagd Svendsen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Louise Fleng Sandal
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Per Kjær
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Barbara I Nicholl
- Institute of Health and Wellbeing, General Practice & Primary Care, University of Glasgow, Glasgow, United Kingdom
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom
| | - Frances Mair
- Institute of Health and Wellbeing, General Practice & Primary Care, University of Glasgow, Glasgow, United Kingdom
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Mette Jensen Stochkendahl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Paul Jarle Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Charlotte Rasmussen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
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Eilayyan O, Thomas A, Hallé MC, Tibbles AC, Jacobs C, Ahmed S, Schneider MJ, Al Zoubi F, Lee J, Myrtos D, Long CR, Bussieres A. Promoting the use of a self-management strategy among novice chiropractors treating individuals with spine pain: A mixed methods pilot clustered-clinical trial. PLoS One 2022; 17:e0262825. [PMID: 35061845 PMCID: PMC8782363 DOI: 10.1371/journal.pone.0262825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 01/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background The uptake of Self-Management Support (SMS) among clinicians is suboptimal. To date, few studies have tested knowledge translation (KT) interventions to increase the application of SMS in chiropractic teaching clinics. Study objective Evaluate the feasibility of implementing a KT intervention to promote the use of a SMS strategy among chiropractic interns, their supervisors, and individuals with spine pain compared to controls. Methods Mixed methods pilot clustered-clinical trial. Clusters of 16 Patient Management Teams were allocated to a complex KT intervention (online and workshop training). Primary feasibility outcomes for clinicians, interns and patients were rates of recruitment, retention, and adherence to protocol. A nominal group technique and interviews were used to seek end-users’ views on the implementation process, and generate possible solutions. Results In total, 16 (84%) clinicians, 65 (26%) interns and 42 patients agreed to participate. All clinicians in the intervention group completed all KT intervention components, 23 interns (85%) completed the online training and 14 interns (51.8%) attended the workshop training. All clinicians in the intervention and seven (78%) in the control group completed all outcome measures at baseline and 6-month follow-up, while 15 (55.6%) and 23 (60.5%) interns in the intervention and control groups completed the questionnaires at baseline and 6-month follow-up, respectively. Among patients, 10 (52.6%) and 12 (52.2%) in the intervention and control groups respectively completed the questionnaires at the end of the study. Based on interview findings, solutions to improve the feasibility of conducting a full trial include: making SMS a part of the internship, changing the time of introducing the study to the interns, and having more training on SMS. Conclusion Recruitment and retention of chiropractic interns and patients for a larger implementation trial in a single outpatient teaching clinic may be challenging.
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Affiliation(s)
- Owis Eilayyan
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
- Physical Therapy and Rehabilitation Department, College of Applied Medical Sciences, Jouf University, Sakaka, Jouf, Saudi Arabia
- * E-mail: ,
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Quebec, Canada
| | - Marie-Christine Hallé
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Quebec, Canada
| | | | - Craig Jacobs
- Canadian Memorial Chiropractic College, Ontario, Canada
| | - Sara Ahmed
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Quebec, Canada
| | - Michael J. Schneider
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Fadi Al Zoubi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Joyce Lee
- Canadian Memorial Chiropractic College, Ontario, Canada
| | - Danny Myrtos
- Canadian Memorial Chiropractic College, Ontario, Canada
| | - Cynthia R. Long
- Palmer College of Chiropractic, Davenport, Iowa, United States of America
| | - Andre Bussieres
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Quebec, Canada
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ALMEIDA NICOLE, PALADINI LUISHENRIQUE, DIAS LUCASVINICIUS, SALES RAMONSCHMIDTDE, MACEDO ANACAROLINABRANDTDE. IMMEDIATE ANALGESIC EFFECT OF 4KHZ AMFS INTERFERENTIAL CURRENT ON CHRONIC LOW BACK PAIN. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222102253908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To analyze the immediate effect of amplitude modulation frequencies (AMFs) of 4kHz interferential current (IFC) on chronic low back pain (CLBP). Method: This is a randomized controlled clinical trial. Sixty-three subjects with CLBP were recruited. The subjects were randomized into 3 groups: the placebo group (PG, n=21) and 2 intervention groups (IG), IG4kHz/2Hz (n=21) and IG4kHz/100Hz (n=21). All groups were submitted to a single session of 30 minutes. Pain was evaluated using a numerical rating scale (NRS), the McGill Pain Questionnaire (MPQ), and pressure algometry. Flexibility was evaluated using the Modified Schober Test (MST), the Sit-and-Reach Test (SRT), the Fingertip-to-Floor Test (FTF), and the Passive Straight-Leg Raise Test (PSLR). Results: Comparing IG4kHz/100Hz with PG, we found a significant difference (p<0.05) in NRS in the total and in the MPQ categories, whereas in the comparison between IG4kHz/2Hz and PG, we found a significant difference only in the sensory and evaluative categories of MPQ. Regarding the flexibility tests, we observed a significant difference of both IG4kHz/100Hz and IG4kHz/2Hz in comparison to PG in MST and PSLR, and of IG4kHz/2Hz in comparison to PG in SRT. The 4kHz IFC was effective in immediately reducing CLBP and, consequently, in increasing the flexibility of the lumbar spine and lower limbs. Conclusion: Conclusion: There was a greater number of significant positive outcomes when the 100Hz AMF was adopted. Level of Evidence I; High quality randomized clinical trial with or without statistically significant differences, but with narrow confidence intervals.
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Bilterys T, Van Looveren E, Mairesse O, Nijs J, Meeus M, Ickmans K, Cagnie B, Goubert D, Willaert W, De Pauw R, Danneels L, Moens M, Malfliet A. Predictors for physical activity and its change after active physical therapy in people with spinal pain and insomnia: Secondary analysis of a randomized controlled trial. Braz J Phys Ther 2022; 26:100456. [PMID: 36372043 PMCID: PMC9661644 DOI: 10.1016/j.bjpt.2022.100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/22/2022] [Accepted: 10/19/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In healthy people and people with nonspecific chronic spinal pain (nCSP) and/or insomnia, participation in physical activity on a regular basis has several physical and psychological health benefits. However, people with chronic conditions often tend to reduce physical activity participation which can lead to deconditioning over time. Currently, there are no known predictors for an (in)active lifestyle (before and after physical therapy treatment) in people with chronic spinal pain and comorbid insomnia. OBJECTIVE To examine predictors of pre-treatment moderate-to-vigorous physical activity (MVPA) and to examine determinants for a change in MVPA in response to 14-weeks of active physical therapy treatment in people with nonspecific chronic spinal pain (nCSP) and comorbid insomnia. METHODS Baseline data and post-treatment data were analyzed for 66 participants. A linear multiple regression analysis was conducted to examine which factors predict MVPA at baseline. Linear mixed-effects modeling was used to identify determinants for change in MVPA in response to an active physical therapy treatment. RESULTS Physical fatigue (b = -0.9; 95%CI: -1.59, -0.15), less limitations in functioning as a result of emotional problems (b = 0.1; 95%CI: 0.03, 0.10), mental fatigue (b = -1.0; 95%CI: -1.67, -0.43), lower general sleep quality (b= 0.7; 95%CI: 0.22, 1.17), and body mass index (b = -0.5; 95%CI: -0.93, -0.16) were significant predictors of baseline MVPA. The regression model explained 33.3% of the total variance in baseline MVPA. The change of MVPA in response to the treatment ranged from a decrease of 17.5 to an increase of 16.6 hours per week. No determinants for change in MVPA after treatment could be identified. CONCLUSION People with nCSP and comorbid insomnia are more likely to engage in MVPA if they report, at baseline, lower sleep quality, fewer limitations in functioning resulting from emotional problems, lower body mass index, as well as less physical and mental fatigue.
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Affiliation(s)
- Thomas Bilterys
- Pain in Motion Research Group (PAIN), Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Department of Rehabilitation Sciences and Physical Therapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium,Pain in Motion International Research Group
| | - Eveline Van Looveren
- Pain in Motion Research Group (PAIN), Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Department of Rehabilitation Sciences and Physical Therapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium,Pain in Motion International Research Group
| | - Olivier Mairesse
- Brain, Body and Cognition, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium,Sleep Laboratory and Unit for Clinical Chronobiology, Bregman University Hospital, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Pain in Motion International Research Group,Department of Physical Medicine and Physcal Therapy, University Hospital Brussels, Brussels, Belgium,Department of Health and Rehabilitation, Unit of Physical Therapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden. University of Gothenburg Center for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physical Therapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium,Pain in Motion International Research Group,Department of Rehabilitation Sciences and Physical Therapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Pain in Motion International Research Group,Department of Physical Medicine and Physcal Therapy, University Hospital Brussels, Brussels, Belgium,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physical Therapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Dorien Goubert
- Department of Rehabilitation Sciences and Physical Therapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Ward Willaert
- Pain in Motion Research Group (PAIN), Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Department of Rehabilitation Sciences and Physical Therapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium,Pain in Motion International Research Group
| | - Robby De Pauw
- Department of Rehabilitation Sciences and Physical Therapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physical Therapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Maarten Moens
- Pain in Motion International Research Group,Department of Neurosurgery and Radiology, University Hospital Brussels, Brussels, Belgium,Center for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium,Stimulus research group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Pain in Motion International Research Group,Department of Physical Medicine and Physcal Therapy, University Hospital Brussels, Brussels, Belgium,Research Foundation Flanders (FWO), Brussels, Belgium.,Corresponding author at: Pain in Motion, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.
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Hamdalla G, Jabbari GM, Abushegarh MY, Abulnaja YH, Dallak EE, AlHammali KA, Almomin IA, AlHuwaymili AS, AlTwalah SF, Hassan AE, AlRuwaili OM. Review on Lower Back Pain Management in Primary Health Care. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/pefqvhsg8e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Knudsen RH, Thomsen JL, Andersen CA, Afzali T, Riis A. Involving practice nurse and other assistant clinical staff members in the management of low back pain: A qualitative interview study from Danish general practice. SAGE Open Med 2021; 9:20503121211039660. [PMID: 34777804 PMCID: PMC8580501 DOI: 10.1177/20503121211039660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives Involving practice nurse and other assistant clinical staff members in providing information and education to patients with low back pain at follow-up appointments may release more time and improve care in general practice. However, this requires a shift in the division of tasks, and general practitioners' barriers and facilitators for this are currently unknown. The objectives were to explore general practitioners' experiences and perceptions of including assistant clinical staff members in the management of low back pain. Methods This is a semi-structured interview study in Danish general practice. General practitioners with a variation in demographics and experience with task-delegation to clinical staff were recruited for in-depth interviews. We used a phenomenological approach to guide the data collection and the analysis in order to gain insight into the subjective experiences of the general practitioners and to understand the phenomenon of 'delegating tasks to practice staff' from the perspective of the general practitioners' lifeworld. Analysis was conducted using an inductive descriptive method. The sample size was guided by information power. Results We conducted five interviews with general practitioners. All general practitioners had experience with task delegation, but there was a variation in which tasks the general practitioners delegated and to which types of clinical staff members. The following themes were derived from the analysis: general practice organisation, delegating to clinical staff members, doctor-patient relationship, exercise instruction, clinical pathway for patients and external support. Conclusion General practitioners consider patients with low back pain to be a heterogeneous group with a variety of treatment needs and a patient group without any predetermined content or frequency of consultations; this can be a barrier for delegating these patients to clinical staff members.
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Affiliation(s)
- Randi H Knudsen
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Janus L Thomsen
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | | | - Tamana Afzali
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Allan Riis
- Center for General Practice, Aalborg University, Aalborg, Denmark.,Department of Physiotherapy, University College Northern Denmark, Aalborg, Denmark
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Corso M, Cancelliere C, Mior S, Salmi LR, Cedraschi C, Nordin M, Sci DM, Taylor-Vaisey A, Côté P. Are Nonpharmacologic Interventions Delivered Through Synchronous Telehealth as Effective and Safe as In-Person Interventions for the Management of Patients With Nonacute Musculoskeletal Conditions? A Systematic Rapid Review. Arch Phys Med Rehabil 2021; 103:145-154.e11. [PMID: 34736919 DOI: 10.1016/j.apmr.2021.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether nonpharmacologic interventions delivered through synchronous telehealth are as effective and safe compared with in-person interventions for the management of patients with musculoskeletal conditions in improving pain, functioning, self-reported recovery, psychological outcomes, or health-related quality of life using rapid review methods. DATA SOURCES We searched MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials from 2010 to August 2020 for randomized controlled trials (RCTs) published in English or French; we updated our search in January 2021. STUDY SELECTION One reviewer screened citations in 2 phases (phase 1: title/abstract; phase 2: full-text) selecting RCTs comparing synchronous telehealth with in-person care for the management of musculoskeletal conditions. A random 10% sample was screened by 2 independent reviewers with minimum 95% agreement prior to full screening. One reviewer critically appraised and one reviewer validated appraisal for eligible RCTs. DATA EXTRACTION One author extracted participant characteristics, setting, sample size, interventions, comparisons, follow-up period, and outcome data. A second author validated data extraction. DATA SYNTHESIS We summarized the findings narratively. Low- to moderate-quality evidence suggests that synchronous telehealth (ie, videoconference or telephone calls) alone or in combination with in-person care leads to similar outcomes as in-person care alone for nonspecific low back pain, generalized osteoarthritis, hip or knee osteoarthritis, and nonacute headaches in adults. CONCLUSIONS Synchronous telehealth may be an option for the management of nonacute musculoskeletal conditions in adults. However, our results may not be generalizable to rural or low socioeconomic populations. Future research should investigate the outcomes associated the use of new technologies, such as videoconference.
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Affiliation(s)
- Melissa Corso
- Faculty of Health Sciences, Ontario Tech University and Centre for Disability Prevention and Rehabilitation, Oshawa, Ontario, Canada
| | - Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University and Centre for Disability Prevention and Rehabilitation, Oshawa, Ontario, Canada
| | - Silvano Mior
- Faculty of Health Sciences, Ontario Tech University and Centre for Disability Prevention and Rehabilitation, Oshawa, Ontario, Canada; Canadian Memorial Chiropractic College, North York, Ontario, Canada
| | - Louis Rachid Salmi
- Faculty of Health Sciences, Ontario Tech University and Centre for Disability Prevention and Rehabilitation, Oshawa, Ontario, Canada; University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France; CHU de Bordeaux, Pôle de Santé Publique, Service d'Information Médicale, Bordeaux, France
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Faculty of Medicine, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland; Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, University Hospitals of Geneva, Geneva, Switzerland
| | - Margareta Nordin
- Departments of Orthopedic Surgery, New York University, New York, NY
| | - Dr Med Sci
- Departments of Orthopedic Surgery, New York University, New York, NY; Environmental Medicine, NYU Grossman School of Medicine, New York University, New York, NY
| | - Anne Taylor-Vaisey
- Faculty of Health Sciences, Ontario Tech University and Centre for Disability Prevention and Rehabilitation, Oshawa, Ontario, Canada; Canadian Memorial Chiropractic College, North York, Ontario, Canada
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University and Centre for Disability Prevention and Rehabilitation, Oshawa, Ontario, Canada.
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Gevers-Montoro C, Provencher B, Descarreaux M, Ortega de Mues A, Piché M. Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain. FRONTIERS IN PAIN RESEARCH 2021; 2:765921. [PMID: 35295422 PMCID: PMC8915715 DOI: 10.3389/fpain.2021.765921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/27/2021] [Indexed: 12/21/2022] Open
Abstract
Spine pain is a highly prevalent condition affecting over 11% of the world's population. It is the single leading cause of activity limitation and ranks fourth in years lost to disability globally, representing a significant personal, social, and economic burden. For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable. One of the conservative management options available is spinal manipulative therapy (SMT), the main intervention used by chiropractors and other manual therapists. The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness (as it compares to other interventions in more pragmatic settings) and efficacy (as it compares to inactive controls under highly controlled conditions) of SMT for the management of neck pain and low back pain. Additionally, a perspective on the current recommendations on SMT for spine pain and the needs for future research will be provided. In summary, SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy. Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain. Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain. Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT.
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Affiliation(s)
- Carlos Gevers-Montoro
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Cognition, Neurosciences, Affect et Comportement (CogNAC) Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Madrid College of Chiropractic—Real Centro Universitario (RCU) María Cristina, San Lorenzo de El Escorial, Spain
| | - Benjamin Provencher
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Cognition, Neurosciences, Affect et Comportement (CogNAC) Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- GRAN Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Arantxa Ortega de Mues
- Madrid College of Chiropractic—Real Centro Universitario (RCU) María Cristina, San Lorenzo de El Escorial, Spain
| | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Cognition, Neurosciences, Affect et Comportement (CogNAC) Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- *Correspondence: Mathieu Piché
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Wertli MM, Flury JS, Streit S, Limacher A, Schuler V, Ferrante AN, Rimensberger C, Haschke M. Efficacy of metamizole versus ibuprofen and a short educational intervention versus standard care in acute and subacute low back pain: a study protocol of a randomised, multicentre, factorial trial (EMISI trial). BMJ Open 2021; 11:e048531. [PMID: 34645660 PMCID: PMC8515449 DOI: 10.1136/bmjopen-2020-048531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Low back pain (LBP) is among the top three most common diseases worldwide, resulting in a life with pain-related disability. To date, no study has assessed the efficacy of metamizole (dipyrone), a non-opioid analgesic and antipyretic prodrug compared with the conventional non-steroidal anti-inflammatory drug ibuprofen, in patients with an acute LBP episode. Further, it is unclear, whether a short educational intervention is superior to usual care alone. OBJECTIVES The objective of this study is to assess first, whether metamizole is non-inferior to ibuprofen in a new episode of acute or subacute LBP. Second, we aim to assess whether a short educational intervention including evidence-based patient information on the nature of LBP is superior to usual care alone. METHODS AND ANALYSIS An investigator-initiated multicentre, randomised, double blind trial using a factorial design will be performed. A total of 120 participants with a new episode of LBP will be recruited from GP practices, outpatient clinics and from emergency departments, and randomised into four different treatment groups: ibuprofen alone, ibuprofen and short intervention, metamizole alone, metamizole and short intervention. The primary endpoint for the medical treatment will be change in pain assessed on an 11-point Numeric Rating Scale after 14 days. The primary outcome for the short intervention will be change in the Core Outcome Measures Index assessed after 42 days. ETHICS, DISSEMINATION AND FUNDING This study has been approved by the responsible Ethics Board (Ethikkommission Bern/2018-01986) and the Swiss Agency for Therapeutic Products (Swissmedic/2019DR4002). Results will be published in open access policy peer-reviewed journals. The study is funded by the Swiss National Science Foundation (grant number 32 003B-179346). TRIAL REGISTRATION NUMBER NCT04111315.
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Affiliation(s)
- Maria M Wertli
- Department of General Internal Medicine, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Julian S Flury
- Department of General Internal Medicine, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Vanessa Schuler
- Department of General Internal Medicine, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Asha-Naima Ferrante
- Department of General Internal Medicine, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Caroline Rimensberger
- Department of General Internal Medicine, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Manuel Haschke
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
- Department of Clinical Pharmacology and Toxicology, University of Bern, Bern, Switzerland
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Davidson SR, Bolsewicz K, Kamper SJ, Haskins R, Petkovic D, Feenan N, Smith D, O'Flynn M, Pallas J, Williams CM. Perspectives of emergency department clinicians on the challenges of addressing low back pain in the emergency setting: A qualitative study. Emerg Med Australas 2021; 34:199-208. [PMID: 34549519 DOI: 10.1111/1742-6723.13854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify and explore ED clinician perspectives on: (i) why patients with low back pain (LBP) present to the ED and are admitted into hospital from ED; (ii) barriers and enablers they face when providing care to patients with LBP; and (iii) strategies to improve the care of patients with LBP, and associated care processes, in the ED. METHODS We undertook a qualitative exploratory study with ED clinicians (medical officers, nurses and physiotherapists) at a tertiary-level public hospital in New South Wales, Australia, using focus groups and individual interviews. We used thematic analysis to synthesise participant responses to answer the predefined research questions. RESULTS Twenty-one clinicians participated (two individual interviews, 19 focus groups). Perceptions about better access to the ED and advanced care within ED were thought to drive presentations to the ED for LBP. Barriers and enablers to optimal patient care included patient-, clinician- and service-level factors. The main strategies to improve care included a department LBP pathway, modernised patient and clinician resources, better follow-up options post-discharge and improved communication between ED and primary care. CONCLUSION We identified a range of targets to improve LBP management in ED. Clinicians perceived internal and external factors to the ED as influences of ED presentation and hospital admission. Clinicians also reported that patient-, clinician- and service-level barriers and enablers influenced patient management in ED. Strategies suggested by clinicians included improved follow-up options, access to resources and an 'LBP pathway' to support decision making.
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Affiliation(s)
- Simon Re Davidson
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Katarzyna Bolsewicz
- Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,National Centre for Immunisation Research and Surveillance, Sydney, New South Wales, Australia
| | - Steven J Kamper
- School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Allied Health Department, Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Robin Haskins
- Outpatient Services, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Dragan Petkovic
- Emergency Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Nicole Feenan
- Emergency Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Damien Smith
- Physiotherapy Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Michael O'Flynn
- Emergency Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Jeremy Pallas
- Emergency Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia
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A Novel Exercise Facilitation Method in Combination with Cognitive Behavioral Therapy Using the Ikiiki Rehabilitation Notebook for Intractable Chronic Pain: Technical Report and 22 Cases. Healthcare (Basel) 2021; 9:healthcare9091209. [PMID: 34574983 PMCID: PMC8467535 DOI: 10.3390/healthcare9091209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
Recent clinical practice guidelines for chronic pain indicate, with a high evidence level, that the combination of exercise and cognitive behavioral therapy (CBT) is effective. The purpose of this study was to evaluate the effectiveness of an exercise facilitation method in combination with CBT using the "Ikiiki Rehabilitation Notebook" for patients with intractable chronic pain. "Ikiiki" means active in Japanese. A total of 22 cases with chronic low back (n = 13), lower extremity (n = 8), or neck (n = 1) pain were treated using this notebook. Two cases dropped out, leaving 22 cases. Each case was evaluated in terms of the numerical rating scale (NRS) of the pain, activities of daily living (ADL), pain catastrophizing scale (PCS), and quality of life (QOL) at pretreatment and post-treatment. The endpoint of the method was to achieve the long-term goals set by the patients. The mean treatment period was 11.2 months. The outcomes were as follows: improvement of presenteeism: nine cases; enhanced participation in hobbies: seven cases; improved school attendance: two cases; return to work: one case; improvement of self-care and/or self-efficacy: three cases. The NRS, ADL, PCS, and QOL were significantly improved after the treatment. This method is possibly valuable for educating patients about the cause and treatment of chronic pain and actively facilitating exercise and social participation. Further studies are needed to investigate the effectiveness of using this notebook for the patient with intractable chronic pain.
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83
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Bussières A, Cancelliere C, Ammendolia C, Comer CM, Zoubi FA, Châtillon CE, Chernish G, Cox JM, Gliedt JA, Haskett D, Jensen RK, Marchand AA, Tomkins-Lane C, O'Shaughnessy J, Passmore S, Schneider MJ, Shipka P, Stewart G, Stuber K, Yee A, Ornelas J. Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline. THE JOURNAL OF PAIN 2021; 22:1015-1039. [PMID: 33857615 DOI: 10.1016/j.jpain.2021.03.147] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022]
Abstract
Lumbar spinal stenosis (LSS) causing neurogenic claudication (NC) is increasingly common with an aging population and can be associated with significant symptoms and functional limitations. We developed this guideline to present the evidence and provide clinical recommendations on nonsurgical management of patients with LSS causing NC. Using the GRADE approach, a multidisciplinary guidelines panel based recommendations on evidence from a systematic review of randomized controlled trials and systematic reviews published through June 2019, or expert consensus. The literature monitored up to October 2020. Clinical outcomes evaluated included pain, disability, quality of life, and walking capacity. The target audience for this guideline includes all clinicians, and the target patient population includes adults with LSS (congenital and/or acquired, lateral recess or central canal, with or without low back pain, with or without spondylolisthesis) causing NC. The guidelines panel developed 6 recommendations based on randomized controlled trials and 5 others based on professional consensus, summarized in 3 overarching recommendations: (Grade: statements are all conditional/weak recommendations) Recommendation 1. For patients with LSS causing NC, clinicians and patients may initially select multimodal care nonpharmacological therapies with education, advice and lifestyle changes, behavioral change techniques in conjunction with home exercise, manual therapy, and/or rehabilitation (moderate-quality evidence), traditional acupuncture on a trial basis (very low-quality evidence), and postoperative rehabilitation (supervised program of exercises and/or educational materials encouraging activity) with cognitive-behavioral therapy 12 weeks postsurgery (low-quality evidence). Recommendation 2. In patients LSS causing NC, clinicians and patients may consider a trial of serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants. (very low-quality evidence). Recommendation 3. For patients LSS causing NC, we recommend against the use of the following pharmacological therapies: nonsteroidal anti-inflammatory drugs, methylcobalamin, calcitonin, paracetamol, opioids, muscle relaxants, pregabalin (consensus-based), gabapentin (very low-quality), and epidural steroidal injections (high-quality evidence). PERSPECTIVE: This guideline, on the basis of a systematic review of the evidence on the nonsurgical management of lumbar spine stenosis, provides recommendations developed by a multidisciplinary expert panel. Safe and effective non-surgical management of lumbar spine stenosis should be on the basis of a plan of care tailored to the individual and the type of treatment involved, and multimodal care is recommended in most situations.
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Affiliation(s)
- André Bussières
- School of Physical Medicine & Occupational Therapy, McGill University, Montreal, Quebec, Canada; Département Chiropratique, Université du Québec à Trois-Rivières, Quebec, Canada.
| | - Carolina Cancelliere
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
| | - Carlo Ammendolia
- Faculty of Medicine, University of Toronto and Mount Sinai Hospital, Ontario, Canada
| | - Christine M Comer
- Leeds Community Healthcare NHS Trust, Leeds, United Kingdom/ Faculty of Medicine, University of Leeds, United Kingdom
| | - Fadi Al Zoubi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | - Greg Chernish
- Family Medicine at the University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Rikke Krüger Jensen
- NIKKB and Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Andrée-Anne Marchand
- Département Chiropratique, Université du Québec à Trois-Rivières, Quebec, Canada
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
| | - Julie O'Shaughnessy
- Département Chiropratique, Université du Québec à Trois-Rivières, Quebec, Canada
| | - Steven Passmore
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania; Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania
| | | | | | - Kent Stuber
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Albert Yee
- Health Systems Management, Rush University, Chicago, Illinois
| | - Joseph Ornelas
- American Hip Institute, Des Plaines, Illinois; Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania
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Cancelliere C, Boyle E, Côté P, Holm LW, Salmi LR, Cassidy JD. Predicting nonrecovery in adults with incident traffic injuries including post-traumatic headache. ACCIDENT; ANALYSIS AND PREVENTION 2021; 159:106265. [PMID: 34182320 DOI: 10.1016/j.aap.2021.106265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/07/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
IMPORTANCE The management of traffic injuries is challenging for clinicians. Knowledge about predictors of nonrecovery from traffic injuries may help to improve patient care. OBJECTIVE To develop a prediction model for self-reported overall nonrecovery from traffic injuries six months post-collision in adults with incident traffic injuries including post-traumatic headache (PTH). DESIGN Inception cohort studies of adults with incident traffic injuries (including PTH) injured in traffic collisions between November 1997 and December 1999 in Saskatchewan, Canada; and between January 2004 and January 2005 in Sweden. METHODS Prediction model development and geographical external validation. SETTING The Saskatchewan cohort (development) was population-based (N = 4,162). The Swedish cohort (validation) (N = 379) were claimants from two insurance companies covering 20% of cars driven in Sweden in 2004. PARTICIPANTS All adults injured in traffic collisions who completed a baseline questionnaire within 30 days of collision. Excluded were those hospitalized > 2 days, lost consciousness > 30 min, or reported headache < 3/10 on the numerical rating scale. Follow-up rates for both cohorts were approximately 80%. PREDICTORS Baseline sociodemographic, pre-injury, and injury factors. OUTCOME Self-reported nonrecovery from all injuries (not "all better (cured)" on the self-perceived recovery scale) six months after traffic collision. RESULTS Both cohorts were predominantly female (69.8% in Saskatchewan, 65.2% in Sweden), with median ages 35.9 years (Saskatchewan), and 38.0 years (Sweden). Predictors were age, low back pain, symptoms in arms or hands, hearing problems, sleeping problems, pre-existing headache, and lower recovery expectations. With a positive score (i.e., ≥0.85 probability), the model can rule in the presence of self-reported nonrecovery from all injuries at six months (development: specificity = 91.3%, 95% CI 89.2%-93.0%; sensitivity = 27.8%, 95% CI 26.0%-29.7%; positive likelihood ratio (LR + ) = 3.2, 95% CI 2.5-4.0; negative likelihood ratio (LR-) = 0.79, 95% CI 0.76-0.82; validation: specificity = 72.6%, 95% CI 61.4%-81.5%; sensitivity = 60.5%, 95% CI 53.9%-66.7%); LR+ = 2.2, 95% CI 1.5-3.3; LR- = 0.5, 95% CI 0.4-0.7). CONCLUSIONS AND RELEVANCE In adults with incident traffic injuries including PTH, predictors other than those related to baseline head and neck pain drive overall nonrecovery. Developing and testing interventions targeted at the modifiable predictors may help to improve outcomes for adults after traffic collision.
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Affiliation(s)
- Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Science Building, Room 3000, Oshawa, Ontario L1H 7K4, Canada; Centre for Disability Prevention and Rehabilitation at Ontario Tech Universtiy and the Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
| | - Eleanor Boyle
- Department of Sport Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Science Building, Room 3000, Oshawa, Ontario L1H 7K4, Canada; Centre for Disability Prevention and Rehabilitation at Ontario Tech Universtiy and the Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Canada Research Chair in Disability Prevention and Rehabilitation, Ontario Tech University, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada
| | - Lena W Holm
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Louis-Rachid Salmi
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Science Building, Room 3000, Oshawa, Ontario L1H 7K4, Canada; ISPED/Bordeaux School of Public Health, University of Bordeaux, F-33000 Bordeaux, France; Centre INSERM U-1219 Bordeaux Population Health, F-33000 Bordeaux, France; CHU de Bordeaux, Pole de sante Publique, Service d'information médicale, F-33000 Bordeaux, France
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Kim JH, Goo B, Seo BK. Establishing a critical pathway for Korean medical management of lumbar disc herniation: A modified Delphi consensus process. Medicine (Baltimore) 2021; 100:e26991. [PMID: 34414980 PMCID: PMC8376369 DOI: 10.1097/md.0000000000026991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/15/2021] [Indexed: 01/04/2023] Open
Abstract
A modified Delphi method was used to establish a consensus. Stakeholders and experts were invited to participate in the expert panel. Best practice statements and decision-making questionnaires were distributed to the panel. Panel members were asked to mark "Strongly disagree" to "Strongly agree" after a series of statements over several rounds until either a consensus was reached or the decision-making method was deemed unsuitable for reaching a consensus.The most common cause of lumbar pain is intervertebral degeneration, which leads to degenerative disc disease and lumbar disc herniation. There is a lack of unanimity regarding appropriate patient protocols and rehabilitation expectations for Korean medical care. The long-term viability of Korean medical treatment, further adoption in the institutional setting, and specific patient outcomes are contingent on the existence of appropriate Korean medical programs.A Korean medical expert panel of 17 practitioners employed a modified Delphi method to achieve consensus on Korean medical care for lumbar disc herniation. The panel first reviewed the literature and guidelines relevant to Korean medical treatment for lumbar disc herniation. The panel members considered questionnaires intended to determine "standardized" Korean medical care recommendations for patients with a wide range of symptoms of lumbar disc herniation. Each panel member participated in a round of voting, which was followed by an opinion-collecting session online. Consensus was defined as a ≥75% agreement among the respondents.In the first round, 144 questionnaires across 5 domains were administered to the expert panels. After reviewing the responses and open-ended comments collected in the first round, the authors modified the questionnaires to 53 items and proceeded. In round 2, consensus was achieved in all 53 survey questions. The final treatment pathway comprised a standardized and comprehensive care approach for lumbar disc herniations in 4 types of medical institutions.This study identified a core set of evidence- and consensus-based principles that are essential to a comprehensive model of care, incorporating identification, referral, and management of patients with lumbar disc herniation.
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Affiliation(s)
- Jung-hyun Kim
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea
| | - Bonhyuk Goo
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea
| | - Byung-kwan Seo
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
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Petrozzi MJ, Spencer G, Mackey MG. A process evaluation of the Mind Your Back trial examining psychologically informed physical treatments for chronic low back pain. Chiropr Man Therap 2021; 29:32. [PMID: 34404446 PMCID: PMC8369773 DOI: 10.1186/s12998-021-00389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background In chronic conditions, such as back pain, the use of interventions that address physical, social and psychological aspects within a biopsychosocial framework are encouraged, however, applying this holistic multimodal approach in physical therapy practice (i.e., chiropractic and physiotherapy) is challenging. To explore the problem of delivering a biopsychosocially informed package of care in physical therapy practice a recent randomised control trial (RCT) called ‘Mind Your Back’ was conducted to evaluate the effectiveness of a combined physical and internet-delivered psychological intervention (psychologically informed physical treatments) compared to standard treatment for improving disability and self-efficacy in people with chronic LBP. The results of the trial indicated no difference between the two intervention groups. Although high-quality RCTs are considered gold standard for effectiveness of interventions, qualitative research methods embedded within a process evaluation framework are also used to reveal other issues and important information that help to explain clinical trial results, and to further the field of digital health interventions research. Therefore, within a process evaluation framework, the aim is to explore participants experiences of the interventions received throughout the Mind Your Back trial which led to a null result. Methods In-line with recommendations for a process evaluation this study used in-depth interviews and qualitative thematic analysis with participants of both arms of the trial 5–6 months after study completion. Semi-structured telephone interviews were conducted with twenty-five participants to explore their experiences of taking part in the Mind Your Back trial. Interviews were conducted in November 2017, transcribed verbatim and data analysed thematically. Results Two main themes were identified: (1) Personalised support and therapeutic alliance are important, and (2) MoodGYM lacked relevant, personalised and tailored support. Conclusion It is important to deliver tailored digital health supports that is personalised and fosters a therapeutic alliance. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00389-y.
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Affiliation(s)
- M John Petrozzi
- Faculty of Medicine and Health, The University of Sydney, Level 7, Susan Wakil Health Building D18, Sydney, NSW, 2006, Australia.
| | - Grace Spencer
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Martin G Mackey
- Faculty of Medicine and Health, The University of Sydney, Level 7, Susan Wakil Health Building D18, Sydney, NSW, 2006, Australia
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Azharuddin A, Aryandono T, Magetsari R, Dwiprahasto I. Predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus: A prospective study in Indonesia. Asian J Surg 2021; 45:277-283. [PMID: 34384675 DOI: 10.1016/j.asjsur.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/30/2021] [Accepted: 05/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The objective of this study was to identify the predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus (HNP). METHODS A prospective study was conducted between June 2010 and April 2012 in Banda Aceh, Indonesia. Clinical and baseline neurologic examinations such as passive straight leg raising test (SLRT), cross SLRT, and patellar and Achilles reflexes were assessed prior to the conservative management. The patients were evaluated at 2nd, 4th, 8th, 12th and 24th week following commencement of the conservative management. RESULTS We recruited and followed 171 HNP patients of which 35.7% of them had good outcome. At univariate analysis, patients with more than 12 months duration of complaint, those with dominant radicular pain, severe pain intensity (visual analogue scale 7-10), positive SLRT, positive cross SLRT, and reduced motor power of knee extensors (muscle strength grade 1-4), were associated with poor outcome. Multivariate analysis suggested that patients with dominant radicular type of pain were likely to had poor outcome compared to those with dominant back pain (odd ratio (OR) 10.57 with 95% confidence interval (CI) 1.15-96.93). Patients with reduced motor power of knee extensors also had a higher chance to have poor outcome compared to those who were normal (OR: 10.57; 95% CI: 1.15-96.93). CONCLUSION Type of pain and the strength of lower extremities could be able to predict the failure of conservative management in patients with lumbar disc herniation. However, further studies with the bigger sample size are warrant to validate our results.
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Affiliation(s)
- Azharuddin Azharuddin
- Department of Orthopaedic and Traumatology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Department of Orthopaedic and Traumatology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia.
| | - Teguh Aryandono
- Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
| | - Rahadyan Magetsari
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
| | - Iwan Dwiprahasto
- Department of Clinical Pharamacology, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
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88
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Simonsen GD, Jensen TS, Kongsted A. Reassuring Patients With Low Back Pain in Primary Care Consultations: Does it Happen, and Does it Matter? A ChiCo Cohort Study. Clin J Pain 2021; 37:598-606. [PMID: 34010222 PMCID: PMC8270505 DOI: 10.1097/ajp.0000000000000946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/17/2021] [Accepted: 04/21/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Reassurance is an important part of treatment for low back pain (LBP). The Consultation-based Reassurance Questionnaire measures patients' perceived reassurance after health care consultations on 4 subdomains (ie, Data-gathering, Relationship-building, Generic reassurance, Cognitive reassurance). The objectives of this study were to investigate associations between the level of reassurance and outcomes and to investigate if the associations were moderated by patients' risk profile. MATERIALS AND METHODS Adult patients consulting chiropractors for LBP were emailed the Consultation-based Reassurance Questionnaire directly after the consultation. Outcomes were Global Perceived Effect (GPE) after 2 weeks, and pain (Numeric Rating Scale) and disability (Roland-Morris Disability Questionnaire) 2 weeks and 3 months following treatment. Associations with GPE were tested in logistic mixed models. Associations between each reassurance domain and pain and disability were tested in longitudinal analyses using linear mixed models. Moderations by risk profile were tested by introducing an interaction between risk groups and reassurance level. All models were controlled for several potential confounders. RESULTS A total of 2056 patients were included in the study, with 46% reporting LBP for less than a week. Associations between reassurance level and improvement in LBP intensity and disability were weak but positive, whereas associations with GPE were potentially clinically relevant. None of the associations were moderated by psychological risk profile. DISCUSSION Identified associations between reassurance and outcomes were weak, however, for GPE the association might be of a clinically relevant magnitude. The causal relationship is unclear, but with communication always present in a consultation these results suggest that efforts to optimize clinician-patient communication might be worthwhile, also for people with very recent onset of LBP.
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Affiliation(s)
| | - Tue S. Jensen
- Chiropractic Knowledge Hub
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M
- Diagnostic Center—Imaging Section, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Alice Kongsted
- Chiropractic Knowledge Hub
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M
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Freo U, Ruocco C, Valerio A, Scagnol I, Nisoli E. Paracetamol: A Review of Guideline Recommendations. J Clin Med 2021; 10:jcm10153420. [PMID: 34362203 PMCID: PMC8347233 DOI: 10.3390/jcm10153420] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/11/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023] Open
Abstract
Musculoskeletal pain conditions are age-related, leading contributors to chronic pain and pain-related disability, which are expected to rise with the rapid global population aging. Current medical treatments provide only partial relief. Furthermore, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are effective in young and otherwise healthy individuals but are often contraindicated in elderly and frail patients. As a result of its favorable safety and tolerability record, paracetamol has long been the most common drug for treating pain. Strikingly, recent reports questioned its therapeutic value and safety. This review aims to present guideline recommendations. Paracetamol has been assessed in different conditions and demonstrated therapeutic efficacy on both acute and chronic pain. It is active as a single agent and is additive or synergistic with NSAIDs and opioids, improving their efficacy and safety. However, a lack of significant efficacy and hepatic toxicity have also been reported. Fast dissolving formulations of paracetamol provide superior and more extended pain relief that is similar to intravenous paracetamol. A dose reduction is recommended in patients with liver disease or malnourished. Genotyping may improve efficacy and safety. Within the current trend toward the minimization of opioid analgesia, it is consistently included in multimodal, non-opioid, or opioid-sparing therapies. Paracetamol is being recommended by guidelines as a first or second-line drug for acute pain and chronic pain, especially for patients with limited therapeutic options and for the elderly.
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Affiliation(s)
- Ulderico Freo
- Anesthesiology and Intensive Care, Department of Medicine—DIMED, University of Padua, 35122 Padua, Italy;
- Correspondence: ; Tel.: +39-049-821-3090
| | - Chiara Ruocco
- Center for the Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, 20129 Milan, Italy; (C.R.); (E.N.)
| | - Alessandra Valerio
- Department of Molecular and Translational Medicine, University of Brescia, 25100 Brescia, Italy;
| | - Irene Scagnol
- Anesthesiology and Intensive Care, Department of Medicine—DIMED, University of Padua, 35122 Padua, Italy;
| | - Enzo Nisoli
- Center for the Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, 20129 Milan, Italy; (C.R.); (E.N.)
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90
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Ecija C, Catala P, Lopez-Gomez I, Bedmar D, Peñacoba C. What Does the Psychological Flexibility Model Contribute to the Relationship Between Depression and Disability in Chronic Pain? The Role of Cognitive Fusion and Pain Acceptance. Clin Nurs Res 2021; 31:217-229. [PMID: 34301154 DOI: 10.1177/10547738211034307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines the mediator role of cognitive fusion between depressive symptoms, activity avoidance and excessive persistence at different levels of pain acceptance (moderator) among fibromyalgia patients (FM). Using a sample of 231 women, multiple and moderate mediation analyses were conducted with PROCESS. Results showed that depression was positively associated with activity avoidance and excessive persistence. Furthermore, cognitive fusion and pain acceptance were found to mediate the effect of depression in both patterns. Additionally, pain acceptance was found to play a contextual role in cognitive fusion, as a moderator, between depressive symptoms and maladaptive patterns. Specifically, FM patients with high acceptance levels and low levels of depression presented the strongest associations between depression and cognitive fusion. Techniques aimed at reducing cognitive fusion, could be especially beneficial to FM women with high pain acceptance.
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Affiliation(s)
- Carmen Ecija
- Rey Juan Carlos University, Alcorcón, Madrid, Spain
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91
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Papaconstantinou E, Cancelliere C, Verville L, Wong JJ, Connell G, Yu H, Shearer H, Timperley C, Chung C, Porter BJ, Myrtos D, Barrigar M, Taylor-Vaisey A. Effectiveness of non-pharmacological interventions on sleep characteristics among adults with musculoskeletal pain and a comorbid sleep problem: a systematic review. Chiropr Man Therap 2021; 29:23. [PMID: 34238325 PMCID: PMC8268365 DOI: 10.1186/s12998-021-00381-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022] Open
Abstract
Sleep problems are common and may be associated with persistent pain. It is unclear whether non-pharmacological interventions improve sleep and pain in adults with comorbid sleep problems and musculoskeletal (MSK) pain. We conducted a systematic review on the effectiveness of non-pharmacological interventions on sleep characteristics among adults with MSK pain and comorbid sleep problems. We searched MEDLINE, EMBASE, CINAHL, Cochrane Central and PsycINFO from inception to April 2, 2021 for randomized controlled trials (RCTs), cohort, and case-control studies. Pairs of independent reviewers critically appraised and extracted data from eligible studies. We synthesized the findings qualitatively. We screened 8459 records and identified two RCTs (six articles, 467 participants). At 9 months, in adults with insomnia and osteoarthritis pain, cognitive behavioral therapy for pain and insomnia (CBT-PI) was effective at improving sleep (Insomnia Severity Index, ISI) when compared to education (OR 2.20, 95% CI 1.25, 3.90) or CBT for pain (CBT-P) (OR 3.21, 95% CI 1.22, 8.43). CBP-P vs. education was effective at increasing sleep efficiency (wrist actigraphy) in a subgroup of participants with severe pain at baseline (mean difference 5.45, 95% CI 1.56, 9.33). At 18 months, CBT-PI, CBT-P and education had similar effectiveness on sleep and pain or health outcomes. In adults with insomnia and knee osteoarthritis, CBT-I improved some sleep outcomes including sleep efficiency (diary) at 3 months (Cohen's d 0.39, 95% CI 0.24, 1.18), and self-reported sleep quality (ISI) at 6 months (Cohen's d - 0.62, 95% CI -1.01, - 0.07). The intervention was no better than placebo (behavioural desensitization) for improving other sleep outcomes related to sleep onset or pain outcomes. Short-term improvement in sleep was associated with pain reduction at 6 months (WOMAC pain subscale) (sensitivity 54.8%, specificity 81.4%). Overall, in two acceptable quality RCTs of adults with OA and comorbid insomnia, CBT-PI/I may improve some sleep outcomes in the short term, but not pain outcomes in the short or long-term. Clinically significant improvements in sleep in the short term may improve longer term pain outcomes. Further high-quality research is needed to evaluate other non-pharmacological interventions for people with comorbid sleep problems and a range of MSK conditions.
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Affiliation(s)
- Efrosini Papaconstantinou
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street N, Oshawa, ON, L1H 7K4, Canada
- Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street N, Oshawa, ON, L1H 7K4, Canada
- Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Leslie Verville
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street N, Oshawa, ON, L1H 7K4, Canada.
- Centre for Disability Prevention and Rehabilitation, Toronto, Canada.
| | - Jessica J Wong
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street N, Oshawa, ON, L1H 7K4, Canada
- Centre for Disability Prevention and Rehabilitation, Toronto, Canada
- Canadian Memorial Chiropractic College, Toronto, Canada
| | - Gaelan Connell
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street N, Oshawa, ON, L1H 7K4, Canada
- Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Hainan Yu
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street N, Oshawa, ON, L1H 7K4, Canada
- Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Heather Shearer
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street N, Oshawa, ON, L1H 7K4, Canada
- Centre for Disability Prevention and Rehabilitation, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | | | - Danny Myrtos
- Canadian Memorial Chiropractic College, Toronto, Canada
| | - Matthew Barrigar
- Canadian Memorial Chiropractic College, Toronto, Canada
- College of Chiropractic Orthopaedic Specialists (Canada), Toronto, Canada
| | - Anne Taylor-Vaisey
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street N, Oshawa, ON, L1H 7K4, Canada
- Centre for Disability Prevention and Rehabilitation, Toronto, Canada
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92
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Wan KR, Zeng GQ, Li Y, Wu JW, Zou BY, Liang HR, Jiang M. Quality changes of clinical practice guidelines for respiratory diseases in China: A systematic review. CLINICAL RESPIRATORY JOURNAL 2021; 15:983-991. [PMID: 34075702 DOI: 10.1111/crj.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND After the low quality of Chinese clinical practice guidelines (CPGs) for respiratory diseases published from 1979 to 2013 was reported, some handbooks were published to standardize guidelines' development recently. There was a great increase in the production and dissemination of CPGs annually in China, whose quality and potential impact were unknown. METHODS A systematic search of four literature databases was performed for the period January 2013 to December 2018 to identify Chinese CPGs for respiratory diseases. Eligible CPGs were evaluated using the appraisal of guidelines for research and evaluation II (AGREE II) instrument. RESULTS A total of 197 CPGs were identified for review. Compared with the result of previous study, the increased scores of the six AGREE II domains were screened: Scope and purpose (57.3% vs. 57.8%), Stakeholder involvement (17.6% vs. 25.0%), Rigor of development (10.2% vs. 13.2%), Clarity and presentation (55.2% vs. 58.4%), Applicability (9.3% vs. 25.9%), and Editorial independence (1.1% vs. 6.3%). The improved overall assessment for included CPGs were: Recommended (4, 2.0% vs. 0, 0%) and Recommended with modifications (26, 13.2% vs. 3, 2.8%). The improved level of evidence used to make recommendations were 59, 11.9% versus 168, 22.4% and 88, 17.7% versus 195, 26.0%, A and B, respectively. CONCLUSIONS The overall quality of CPGs for respiratory diseases published from 2013 to 2018 in China was slightly improved, but had a big gap with the optimum level, especially in Rigor of development and Editorial independence. Increased efforts are required to enable the development of high-quality evidence-based CPGs for respiratory diseases.
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Affiliation(s)
- Kai-Rui Wan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Cancer Research Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guang-Qiao Zeng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yao Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jun-Wan Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bang-Yu Zou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Heng-Rui Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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93
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Davidson SRE, Kamper SJ, Haskins R, Robson E, Gleadhill C, da Silva PV, Williams A, Yu Z, Williams CM. Exercise interventions for low back pain are poorly reported: a systematic review. J Clin Epidemiol 2021; 139:279-286. [PMID: 34091020 DOI: 10.1016/j.jclinepi.2021.05.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the reporting quality of exercise interventions from clinical trials of low back pain (LBP). STUDY DESIGN AND SETTING We conducted a systematic review to assess the reporting quality of randomised controlled trials (RCTs) that investigated the effectiveness of exercise interventions for patients with LBP. Five online databases and Clinical Trial Registries were searched (October 2018). We included RCTs that reported interventions for LBP, containing at least 50% exercise. The Template for Intervention Description and Replication (TIDieR) and the Consensus on Exercise Reporting Template (CERT) reporting checklists were then used to assess quality of reporting. RESULTS 582 trials were eligible for inclusion. Due to the large number of eligible studies, 100 studies were randomly selected for data extraction and coding with the TIDieR and CERT checklists. The random sample was representative of the 582 eligible trials. The overall completeness of reporting (median (IQR)) of TIDieR items was 59.2% (45.5%-72.7%) and CERT was 33.3% (22.2%-52.6%). CONCLUSIONS We found poor overall reporting with both checklists, which has not improved over time or since the introduction of the checklists. More dedicated work is required to address poor reporting of exercise interventions in clinical trials.
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Affiliation(s)
- Simon R E Davidson
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW, 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend NSW, 2287, Australia.
| | - Steven J Kamper
- School of Health Sciences, University of Sydney, PO Box M179, Missenden Rd, Camperdown NSW, 2050, Australia; Nepean Blue Mountains Local Health District, Penrith NSW, 2750, Australia
| | - Robin Haskins
- John Hunter Hospital Outpatient Services, Lookout Road, New Lambton Heights NSW, 2305, Australia
| | - Emma Robson
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW, 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend NSW, 2287, Australia
| | - Connor Gleadhill
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW, 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend NSW, 2287, Australia
| | - Priscilla Viana da Silva
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW, 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend NSW, 2287, Australia
| | - Amanda Williams
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW, 2308, Australia
| | - Zhongming Yu
- Community Therapy, 71 Ronald Avenue, Shoal Bay NSW, 2315, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW, 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend NSW, 2287, Australia
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Widerström B, Elvén M, Rasmussen-Barr E, Boström C. "How does physical examination findings influence physiotherapists' decision-making when matching treatment to patients with low back pain?". Musculoskelet Sci Pract 2021; 53:102374. [PMID: 33798815 DOI: 10.1016/j.msksp.2021.102374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/10/2021] [Accepted: 03/20/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Further clinical data how low-back pain (LBP) symptoms and signs manifests in physiotherapy clinical reasoning and treatment decision-making is needed. OBJECTIVE The aim was to explore and describe how symptoms and signs portrayed in three case descriptions of LBP influences physiotherapy treatment decision-making. DESIGN This was an exploratory interview study using inductive content analysis. METHOD Fifteen semi-structured individual interviews were used to collect data of physiotherapists' treatment decision-making regrading three diverse LBP case descriptions. The participants were men, women, experienced and novice, working in primary healthcare settings in one sparsely populated region and in one larger city in Sweden. FINDINGS Two overarching themes were identified influencing decision-making for the treatment of LBP:1) Explicit assessment features distinguish treatment approaches; with categories describing how symptoms and signs were used to target treatment (nature of pain induce reflections on plausible cause; narrative details trigger attention and establishes knowledge-enhancing foci; pain-movement-relationship is essential; diverse emphasis of pain modulation and targeted treatment approaches): and 2) Preconceived notion of treatment, with categories describing personal treatment rationales, unrelated to the presented symptoms and signs (passive treatment avoidance and motor control exercise ambiguity). CONCLUSION This study identifies how assessment details lead to decisions on diverse treatment approaches for LBP, but also that treatment decisions can be based on preconceived beliefs unrelated to the clinical presentation. The results underpin the mix of knowledge sources that clinicians need to balance and the necessity of self-awareness of preconceptions for informed and meaningful clinical decision-making.
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Affiliation(s)
| | - Maria Elvén
- Mälardalen University, School of Health, Care and Social Welfare, Division of Physiotherapy, Västerås, Sweden
| | | | - Carina Boström
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
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Guimarães LDS, Costa LDCM, Araujo AC, Nascimento DP, Medeiros FC, Avanzi MA, Leal-Junior ECP, Costa LOP, Tomazoni SS. Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Pain 2021; 162:1612-1620. [PMID: 33449509 DOI: 10.1097/j.pain.0000000000002189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT Photobiomodulation therapy (PBMT) has been used in several musculoskeletal disorders to reduce pain, inflammation, and promoting tissue regeneration. The current evidence about the effects of PBMT on low back pain (LBP) is still conflicting. We aimed to evaluate the effects of PBMT against placebo on pain intensity and disability in patients with chronic nonspecific LBP. This was a prospectively registered, randomised placebo-controlled trial, with blinded patients, therapists, and assessors. The study was conducted on an outpatient physical therapy clinic in Brazil, between April 2017 and May 2019. A total of 148 patients with chronic nonspecific LBP were randomised to either active PBMT (n = 74) or placebo (n = 74). Patients from both groups received 12 treatment sessions, 3 times a week, for 4 weeks. Patients from both groups also received an educational booklet based on "The Back Book." Clinical outcomes were measured at baseline and at follow-up appointments at 4 weeks, 3, 6, and 12 months after randomisation. The primary outcomes were pain intensity and disability measured at 4 weeks. We estimated the treatment effects using linear mixed models following the principles of intention-to-treat. There was no clinical important between-group differences in terms of pain intensity (mean difference = 0.01 point; 95% confidence interval = -0.94 to 0.96) and disability (mean difference = -0.63 points; 95% confidence interval = -2.23 to 0.97) at 4 weeks. Patients did not report any adverse events. Photobiomodulation therapy was not better than placebo to reduce pain and disability in patients with chronic nonspecific LBP.
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Affiliation(s)
- Layana de Souza Guimarães
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | | | - Amanda Costa Araujo
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Dafne Port Nascimento
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Flávia Cordeiro Medeiros
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Marina Athayde Avanzi
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Ernesto Cesar Pinto Leal-Junior
- Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
- Post-graduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Leonardo Oliveira Pena Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Shaiane Silva Tomazoni
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
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96
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Sorondo D, Delpierre C, Côté P, Salmi LR, Cedraschi C, Taylor-Vaisey A, Lemeunier N. Determinants of clinical practice guidelines' utilization for the management of musculoskeletal disorders: a scoping review. BMC Musculoskelet Disord 2021; 22:507. [PMID: 34074285 PMCID: PMC8170973 DOI: 10.1186/s12891-021-04204-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Context Many clinical practice guidelines have been developed for the management of musculoskeletal disorders (MSDs). However, there is a gap between evidence-based knowledge and clinical practice, and reasons are poorly understood. Understanding why healthcare providers use clinical practice guidelines is essential to improve their implementation, dissemination, and adherence. Aim To identify determinants of clinical practice guidelines’ utilization by health care providers involved in the assessment and management of MSDs. Method A scoping review of the literature was conducted. Three databases were searched from inception to March 2021. Article identification, study design, methodological quality, type of healthcare providers, MSDs, barriers and facilitators associated with guidelines’ utilization were extracted from selected articles. RESULTS: 8671 citations were retrieved, and 43 articles were selected. 51% of studies were from Europe, and most were quantitative studies (64%) following a cross-sectional design (88%). Almost 80% of articles dealt with low back pain guidelines, and the most studied healthcare providers were general practitioners or physiotherapists. Five main barriers to guideline utilization were expressed by providers: 1) disagreement between recommendations and patient expectations; 2) guidelines not specific to individual patients; 3) unfamiliarity with “non-specific” term, or with the bio psychosocial model of MSDs; 4) time consuming; and 5) heterogeneity in guideline methods. Four main facilitators to guideline utilization were cited: 1) clinician’s interest in evidence-based practice; 2) perception from clinicians that the guideline will improve triage, diagnosis and management; 3) time efficiency; and 4) standardized language. Conclusion Identifying modifiable determinants is the first step in developing implementation strategies to improve guideline utilization in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04204-w.
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Affiliation(s)
- Delphine Sorondo
- UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France. .,Institut Franco-Européen de Chiropraxie, 72 chemin de la Flambère-31,300, Toulouse, France.
| | - Cyrille Delpierre
- UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Centre for Disability Prevention and Rehabilitation at Ontario Tech University and the Canadian Memorial Chiropractic College, Oshawa and Toronto, Ontario, Canada
| | - Louis-Rachid Salmi
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, University of Geneva, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Taylor-Vaisey
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Centre for Disability Prevention and Rehabilitation at Ontario Tech University and the Canadian Memorial Chiropractic College, Oshawa and Toronto, Ontario, Canada
| | - Nadège Lemeunier
- UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
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97
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Online Videos as a Source of Physiotherapy Exercise Tutorials for Patients with Lumbar Disc Herniation-A Quality Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115815. [PMID: 34071461 PMCID: PMC8198219 DOI: 10.3390/ijerph18115815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 12/22/2022]
Abstract
Background: During the last few decades the prevalence of lumbar disc herniation has been increasing constantly, thereby imposing a significant socioeconomic burden. Physiotherapy plays a crucial role in both surgical and conservative treatment of lumbar disc herniation, consequently the current COVID-19 pandemic with concomitant lockdowns has led to a shortage of physiotherapeutical care. In the light of these recent events publicly available physiotherapy tutorials may be a useful tool to address this problem. Aim: The main aim of this study was to assess the quality of online physiotherapy exercise tutorials for lumbar disc herniation. Materials & Methods: With YouTube being a widely known and used platform we screened 240 of the most viewed videos. A total of 76 videos met the inclusion criteria and were statistically analyzed. The videos were assessed using Global Quality Score, DISCERN Score and JAMA benchmark criteria and in regard to their applicability. Results: They displayed a wide range of views (44,969 to 5,448,717), likes (66 to 155,079) and dislikes (6 to 2339). The videos were assessed using Global Quality Score, DISCERN Score and JAMA benchmark criteria and in regard to their applicability. Neither the number of "Views", "Likes", nor "Dislikes" was found to have a significant association with any of the quality measures used in this study. Conclusion: Overall quality grade was determined as "moderate". Based on the data examined in this study, the use of YouTube videos as a source of therapy advice for lumbar spine disc herniation cannot be recommended universally.
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98
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Clinical guidelines and care pathway for management of low back pain with or without radicular pain. Joint Bone Spine 2021; 88:105227. [PMID: 34051387 DOI: 10.1016/j.jbspin.2021.105227] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/11/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To develop guidelines for low back pain management according to previous international guidelines and the updated literature. METHODS A report was compiled from a review of systematic reviews of guidelines published between 2013 and 2018 and meta-analysis of the management of low back pain published between 2015 and 2018. This report summarized the state-of-the-art scientific knowledge for each predefined area of the guidelines from a critical review of selected literature. A multidisciplinary panel of experts including 17 health professionals involved in low back pain management and 2 patient representatives formulated preliminary guidelines based on the compilation report and a care pathway. The compilation report and preliminary guidelines were submitted to 25 academic institutions and stakeholders for the consultation phase. From responses of academic institutions and stakeholders, the final guidelines were developed. For each area of the guidelines, agreement between experts was assessed by the RAND/UCLA method. RESULTS The expert panel drafted 32 preliminary recommendations including a care pathway, which was amended after academic institution and stakeholder consultation. The consensus of the multidisciplinary expert panel was assessed for each final guideline: 32 recommendations were assessed as appropriate; none was assessed as uncertain or inappropriate. Strong approval was obtained for 27 recommendations and weak for 5. CONCLUSION These new guidelines introduce several concepts, including the need to early identify low back pain at risk of chronicity to provide quicker intensive and multidisciplinary management if necessary.
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99
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Longtin C, Décary S, Cook CE, Tousignant-Laflamme Y. What does it take to facilitate the integration of clinical practice guidelines for the management of low back pain into practice? Part 1: A synthesis of recommendation. Pain Pract 2021; 21:943-954. [PMID: 33998769 DOI: 10.1111/papr.13033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/18/2021] [Accepted: 03/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the emergence of multiple clinical practice guidelines (CPGs) for the rehabilitation of low back pain (LBP) over the last decade, self-reported levels of disability in this population have not improved. This may be explained by the numerous implementation barriers, such as the complexity of information and sheer volumes of CPGs. OBJECTIVES The purpose of this study was to summarize the evidence and recommendations from the most recent and high-quality CPGs on the rehabilitation management of LBP by developing an infographic summarizing the recommendations to facilitate dissemination into clinical practice. METHODS We performed a systematic review of high-quality CPGs with an emphasis on rehabilitation approaches. We searched major health-related research databases (e.g., PubMed, CINAHL, and PEDro). We performed quality assessment via the AGREE-II instrument. Contents of the CPGs were synthesized by extracting recommendations, which were then compared to one another to identify consistencies based on an iterative evaluation process. RESULTS We identified and assessed 5 recent high-quality CPGs. We synthesized 13 recommendations on the rehabilitation management of LBP (2 for screening procedures, 3 for assessment procedures, and 8 involving treatment approaches) and 2 underlying principles were highlighted. These results were then synthetized and illustrated in a concise infographic that serves as a conceptual roadmap that identifies the specific behavior changes (i.e., adoption of CPGs' recommendations) rehabilitation professionals should adopt in order to integrate an evidenced-based approach for the management of LBP. CONCLUSIONS We systematically reviewed the literature for CPGs' recommendations for the physical rehabilitation management of LBP and synthesized the information through an infographic.
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Affiliation(s)
- Christian Longtin
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada
| | - Simon Décary
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada.,Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
| | - Chad E Cook
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada.,Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
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100
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Zheng Q, Wang R, Shi Y, Sun Q. Effects of acupoint massage combined with relaxation therapy on patients with postoperative fatigue syndrome after lumbar surgery. Medicine (Baltimore) 2021; 100:e25849. [PMID: 34106628 PMCID: PMC8133127 DOI: 10.1097/md.0000000000025849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND : Lumbar disc herniation (LDH) is a common disease in orthopedics. Surgery is shown to provide significant faster relief of pain compared to conservative therapy. However, due to the influence of surgical trauma, anesthesia and other perioperative stress factors, patients may have complications. Among them, postoperative fatigue syndrome (POFS) is a common complication. Traditional Chinese medicine or integrated traditional Chinese and Western medicine have been proved to be effective in improving postoperative fatigue. METHODS : This study is a randomized controlled trial. One hundred eighty Chinese patients with POFS of LDH will be randomly divided into control group, experimental group 1, experimental group 2 and experimental group 3 according to the ratio of 1:1:1:1. The patients in the control group will be treated with conventional treatment after operation, the patients in the experimental group 1 will be treated with acupoint massage, the patients in the experimental group 2 will be treated with relaxation therapy, and the patients in the experimental group 3 will be treated with acupoint massage combined with relaxation therapy. The whole treatment will last for 5 days. The main outcome measures will be fatigue visual analogue scale and identity-consequence fatigue scale, and the secondary outcome measures will be hospital anxiety and depression scale. DISCUSSION : This study is to observe the effects of acupoint massage comblined with relaxation therapy on reducing postoperative fatigue of lumbar disc herniation surgical patients. TRIAL REGISTRATION : Chinese Clinical Trial Registry (http://www.chictr.org.cn/edit.aspx?pid=123978&htm=4), No. ChiCTR2100044788. Registered on March 27, 2021.
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Affiliation(s)
- Qiuhui Zheng
- Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University
| | - Rongyun Wang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yanan Shi
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qiuhua Sun
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
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