51
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Disorders of the Neck and Back. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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52
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Rehabilitation Using a Systematic and Holistic Approach for the Injured Athlete Returning to Sport. Arthrosc Sports Med Rehabil 2022; 4:e215-e219. [PMID: 35141554 PMCID: PMC8811513 DOI: 10.1016/j.asmr.2021.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
The purpose of this article is to identify gold standards of care for return to sport following athletic injury, investigate overlooked aspects of return to sport rehabilitation, and provide expert opinion regarding current practices. The article was written by performing a literature review, then providing editorial expert opinion regarding current standards of return to sport. We concluded, through literature review and expert consensus, that a three-pronged approach to return to sport is recommended for therapists. These three prongs are ROM, strength, and hop testing. Cardiovascular readiness and psychological readiness for return to sport must also be assessed.”
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Alvarez E, Garvin A, Germaine N, Guidoni L, Schnurr M. Use of Mental Health Interventions by Physiotherapists to Treat Individuals with Chronic Conditions: A Systematic Scoping Review. Physiother Can 2022; 74:35-43. [PMID: 35185246 PMCID: PMC8816365 DOI: 10.3138/ptc-2020-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 01/03/2023]
Abstract
Purpose: Physiotherapists work with people with chronic conditions and can act as catalysts for behavioural change. Physiotherapy has also seen a shift to a bio-psychosocial model of health management and interdisciplinary care, which is important in the context of chronic conditions. This scoping review addressed the research question "How do physiotherapists use mental health-based interventions in their treatment of individuals with chronic conditions?" Method: The Embase, MEDLINE, PsycINFO, and CINAHL databases were searched, and a variety of study designs were included. Data were categorized and descriptively analyzed. Results: Data were extracted from 103 articles. Low back pain (43; 41.7%) and non-specified pain (16; 15.5%) were the most commonly researched chronic conditions, but other chronic conditions were also represented. Outpatient facilities were the most common setting for intervention (68; 73.1%). A total of 73 (70.9%) of the articles involved cognitive-behavioural therapy, and 41 (40.0%) included graded exercise or graded activity as a mental health intervention. Conclusions: Physiotherapists can use a variety of mental health interventions in the treatment of chronic conditions. More detailed descriptions of treatment and training protocols would be helpful for incorporating these techniques into clinical practice.
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Affiliation(s)
- Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Garvin
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Germaine
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Guidoni
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Meghan Schnurr
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Pinto SM, Cheung JPY, Samartzis D, Karppinen J, Zheng YP, Pang MYC, Wong AYL. Are Morphometric and Biomechanical Characteristics of Lumbar Multifidus Related to Pain Intensity or Disability in People With Chronic Low Back Pain After Considering Psychological Factors or Insomnia? Front Psychiatry 2022; 13:809891. [PMID: 35492728 PMCID: PMC9053572 DOI: 10.3389/fpsyt.2022.809891] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Lumbar multifidus muscle (LMM) dysfunction is thought to be related to pain and/or disability in people with chronic low back pain (CLBP). Although psychosocial factors play a major role in pain/disability, they are seldom considered as confounders in analyzing the association between LMM and CLBP. OBJECTIVES This study aimed to determine: (1) differences in psychological factors, insomnia, and LMM characteristics between people with and without CLBP; (2) associations between psychological factors, insomnia, or LMM characteristics and low back pain (LBP) intensity or LBP-related disability in people with CLBP; and (3) whether LMM characteristics are related to LBP symptoms in people with CLBP after considering confounders. METHODS Seventy-eight volunteers with CLBP and 73 without CLBP provided sociodemographic information, filled the 11-point numeric pain rating scale and Roland-Morris disability questionnaire (RMDQ). They completed the Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), Fear Avoidance Belief Questionnaire (FAB), and Insomnia Severity Index Scale (ISI). Resting and contracted thickness of LMM at L4-S1 levels were measured from brightness-mode ultrasound images. Percent thickness changes of LMM at L4-S1 levels during contraction were calculated. Resting LMM stiffness at L4-S1 was measured by shear wave elastography. Associations among LMM, psychosocial or insomnia parameters and clinical outcomes were analyzed by univariate and multivariate analyses. RESULTS People with CLBP demonstrated significantly higher LBP-intensity, RMDQ, HADS, FAB, PCS, and ISI scores than asymptomatic controls (p < 0.05). The former also had significantly smaller percent thickness changes of LMM at L4/L5 during contraction. LBP-intensity was positively related to scores of PCS-total, PCS-helplessness, FAB-total, FAB-work, and ISI in people with CLBP (p < 0.05). RMDQ scores were positively associated with the scores of HADS-total, HADS-depression, PCS-total, FAB-total, FAB-physical activity, PCS-helplessness, and ISI in people with CLBP (p < 0.05). FAB-work and ISI scores together explained 24% of LBP-intensity. FAB-total scores alone explained 34% of variance of LBP-related disability in people with CLBP. CONCLUSION More fear-avoidance belief or insomnia is related to greater LBP-intensity and/or LBP-related disability in people with CLBP. Although people with CLBP were thought to have aberrant LMM morphometry/function, no LMM characteristics were related to LBP-intensity or LBP-related disability after considering other confounders.
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Affiliation(s)
- Sabina M Pinto
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, United States
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Salemi MDM, Gomes VMDSA, Bezerra LMR, Melo TMDS, Alencar GGD, Montenegro IHPDM, Calado APDM, Montenegro EJN, Siqueira GRD. Effect of Dry Cupping Therapy on Pain and Functional Disability in Persistent Non-Specific Low Back Pain: A Randomized Controlled Clinical Trial. J Acupunct Meridian Stud 2021; 14:219-230. [DOI: 10.51507/j.jams.2021.14.6.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/10/2021] [Accepted: 09/07/2021] [Indexed: 11/03/2022] Open
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Romanova S, Grigorova K, Dimitrova A. Therapeutic Education and Physiotherapy in Low Back Pain Management. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Low-back pain (LBP) is one of the most common musculoskeletal problems; it is the leading cause of disability worldwide. Therapeutic patient education is a method that enables health care professionals to pass on their knowledge and experience to patients so that they can participate consciously and actively in their recovery.
AIM: The present study aims to examine the effect of therapeutic education (TE) combined with a specific physiotherapy (PT) approach in people with LBP.
МАTERIALS AND METHODS: This was an experimental pre- and post-study design. The study involved 25 patients, mean age 43.08 ± 12 years, divided into two groups: experimental group (EG), with TE (n =18) and control group (CG), without TE (n = 7). The PT treatment frequency and duration were consistent between groups. The patients were monitored for one month, and the intervention under supervision – face-to-face and self-monitored home-based PT have been organized. The included outcome measures were Oswestry Disability Index, Tampa Scale for Kinesiophobia, STarT Back Screening Tools, and the movement-induced pain in the lumbar spine.
RESULTS: At the end of the study improved pain-free movements in the lumbar region, functionality, reduced catastrophizing was observed in both groups. There is a tendency for better results in the EG compared to the CG in terms of functionality and pain-free movement. The subjective feeling of the catastrophizing was reduced only in the EG below the cut-off score from 45.2 ± 7.7 to 33.2 ± 3.3 points.
CONCLUSION: TE in combination with PT interventions improves functional abilities, decreases the pain during movements, and the subjective perception of kinesiophobia. The results suggest TE should be included in a LBP management approach.
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Marshall PW, Morrison NMV, Mifsud A, Gibbs M, Khan N, Meade T. The Moderating Effect of Treatment Engagement on Fear-avoidance Beliefs in People With Chronic Low Back Pain. Clin J Pain 2021; 37:872-880. [PMID: 34636749 DOI: 10.1097/ajp.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The fear-avoidance model (FAM) is used to explain pain-related disability and design targeted interventions for people with chronic low back pain. While treatment engagement is critical, it is unknown how treatment moderates the FAM. METHODS This study examined whether pathways within the FAM were moderated by treatment engagement in 508 people with chronic low back pain. Measures of disability, pain, fear, catastrophizing, anxiety, depression, and self-efficacy were collected through self-report, and descriptors of treatment engaged within the last month (physical activity type, medication, allied and medical health practitioner). Moderated mediation analyses were performed to examine the conditional effect of treatment engagement on fear-avoidance pathways. RESULTS The conditional effect of anxiety on disability was only significant for people who did not report any treatment engagement in the last month (B=1.03, 95% confidence interval: 0.53-1.53, P<0.001). The effect of depression increased for people reporting more different types of treatment in the last month (1 level of treatment increase, B=0.27, 95% confidence interval: 0.05-0.50, P=0.019). Conversely, greater treatment engagement had a positive influence on the mediating effect of self-efficacy. That is, the effect of pain on efficacy reduced with greater treatment engagement, with a concomitant increased effect of self-efficacy on disability. DISCUSSION Clinicians should explore the history and rationale behind patient treatment seeking behavior to ensure this is not reinforcing the negative effects of depressive symptoms on pain-related disability.
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Affiliation(s)
- Paul W Marshall
- Schools of Health Science
- Department of Exercise Sciences, University of Auckland, Auckland, NSW, New Zealand
| | - Natalie M V Morrison
- Medicine
- Translational Health Research Institute, Western Sydney University, Sydney
| | | | | | | | - Tanya Meade
- Psychology
- Translational Health Research Institute, Western Sydney University, Sydney
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Liew BXW, Ford JJ, Scutari M, Hahne AJ. How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data. PLoS One 2021; 16:e0258515. [PMID: 34634071 PMCID: PMC8504753 DOI: 10.1371/journal.pone.0258515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/12/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Individualised physiotherapy is an effective treatment for low back pain. We sought to determine how this treatment works by using randomised controlled trial data to develop a Bayesian Network model. METHODS 300 randomised controlled trial participants (153 male, 147 female, mean age 44.1) with low back pain (of duration 6-26 weeks) received either individualised physiotherapy or advice. Variables with potential to explain how individualised physiotherapy works were included in a multivariate Bayesian Network model. Modelling incorporated the intervention period (0-10 weeks after study commencement-"early" changes) and the follow-up period (10-52 weeks after study commencement-"late" changes). Sequences of variables in the Bayesian Network showed the most common direct and indirect recovery pathways followed by participants with low back pain receiving individualised physiotherapy versus advice. RESULTS Individualised physiotherapy directly reduced early disability in people with low back pain. Individualised physiotherapy exerted indirect effects on pain intensity, recovery expectations, sleep, fear, anxiety, and depression via its ability to facilitate early improvement in disability. Early improvement in disability, led to an early reduction in depression both directly and via more complex pathways involving fear, recovery expectations, anxiety, and pain intensity. Individualised physiotherapy had its greatest influence on early change variables (during the intervention period). CONCLUSION Individualised physiotherapy for low back pain appears to work predominately by facilitating an early reduction in disability, which in turn leads to improvements in other biopsychosocial outcomes. The current study cannot rule out that unmeasured mechanisms (such as tissue healing or reduced inflammation) may mediate the relationship between individualised physiotherapy treatment and improvement in disability. Further data-driven analyses involving a broad range of plausible biopsychosocial variables are recommended to fully understand how treatments work for people with low back pain. TRIALS REGISTRATION ACTRN12609000834257.
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Affiliation(s)
- Bernard X. W. Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - Jon J. Ford
- Discipline of Physiotherapy, School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Australia
| | - Marco Scutari
- Istituto Dalle Molle di Studi sull’Intelligenza Artificiale (IDSIA), Lugano, Switzerland
| | - Andrew J. Hahne
- Discipline of Physiotherapy, School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Australia
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Bemani S, Dehkordi SN, Sarrafzadeh J, Talebian S, Salehi R, Zarei J. Efficacy of a multidimensional versus usual care physiotherapy on pain and electroencephalography (EEG) spectrum in chronic nonspecific low back pain: study protocol for a randomized controlled trial. Trials 2021; 22:679. [PMID: 34620205 PMCID: PMC8499517 DOI: 10.1186/s13063-021-05580-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Non-specific chronic low back pain (NSCLBP) is a major public health and global socioeconomic burden associated with a complex interplay of biopsychosocial factors. Despite scientific signs of progress, treatment of NSCLBP often tends to stick to a biomechanical model, without targeting psychological and social factors. To enhance the clinical efficacy of usual physiotherapy for NSCLBP, the development of clinical strategies is to be pursued. This study aims to assess the effectiveness of multidimensional physiotherapy based on a biopsychosocial approach compared to usual care physiotherapy, on clinical findings and electroencephalography spectrum in non-specific chronic low back pain. METHODS This study is a triple-blind, two-arm (1:1) randomized controlled trial with a 4 months follow-up. Seventy NSCLBP patients will be randomly allocated to either the experimental (multidimensional physiotherapy) or the active control group (usual physiotherapy); each group will receive 6 weeks of physiotherapy. The main outcome is pain and secondary outcomes are brain function, quality of life, disability, lumbar flexion range of motion, and psychosocial correlates. Assessment will be performed at baseline, post-treatment, and at 1 and 4 months follow-up. DISCUSSION Findings may provide evidence on the effectiveness of multidimensional physiotherapy on clinical findings and brain characteristics and might provide evidence towards showing the role of brain and biopsychosocial factors on chronic pain. TRIAL REGISTRATION ClinicalTrials.gov NCT04270422 , Registered on 17 February 2020, IRCT Identifier: IRCT20140810018754N11.
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Affiliation(s)
- Sanaz Bemani
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blv, Tehran, Iran
| | - Shohreh Noorizadeh Dehkordi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blv, Tehran, Iran.
| | - Javad Sarrafzadeh
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blv, Tehran, Iran
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Jamileh Zarei
- Department of Health Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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Simpson P, Holopainen R, Schütze R, O'Sullivan P, Smith A, Linton SJ, Nicholas M, Kent P. Training of Physical Therapists to Deliver Individualized Biopsychosocial Interventions to Treat Musculoskeletal Pain Conditions: A Scoping Review. Phys Ther 2021; 101:6330890. [PMID: 34331758 DOI: 10.1093/ptj/pzab188] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/05/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Current guidelines recommend management of musculoskeletal pain conditions from a biopsychosocial approach; however, biopsychosocial interventions delivered by physical therapists vary considerably in effectiveness. It is unknown whether the differences are explained by the intervention itself, the training and/or competency of physical therapists delivering the intervention, or fidelity of the intervention. The aim was to investigate and map the training, competency assessments, and fidelity checking of individualized biopsychosocial interventions delivered by physical therapists to treat musculoskeletal pain conditions. METHODS A scoping review methodology was employed, using Arksey and O'Malley's framework. Seven electronic databases were searched between January and March 2019, with a bridge search completed in January 2020. Full-text peer-reviewed articles, with an individualized biopsychosocial intervention were considered, and 35 studies were included. RESULTS Reporting overall was sparse and highly variable. There was a broad spectrum of training. More sophisticated training involved workshops combining didactic and experiential learning over longer durations with supervision and feedback. Less sophisticated training was brief, involving lectures or seminars, with no supervision or feedback. Competency assessments and fidelity testing were underperformed. CONCLUSIONS Training in some interventions might not have facilitated the implementation of skills or techniques to enable the paradigm shift and behavior change required for physical therapists to effectively deliver a biopsychosocial intervention. Lack of competency assessments and fidelity checking could have impacted the methodological quality of biopsychosocial interventions. IMPACT This study highlighted problematic reporting, training, assessment of competency, and fidelity checking of physical therapist-delivered individualized biopsychosocial interventions. Findings here highlight why previous interventions could have shown small effect sizes and point to areas for improvement in future interventions. These findings can help inform future research and facilitate more widespread implementation of physical therapist-delivered biopsychosocial interventions for people with musculoskeletal pain and thereby improve their quality of life.
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Affiliation(s)
- Phoebe Simpson
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Riikka Holopainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Robert Schütze
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.,Bodylogic Physiotherapy, Perth, Western Australia, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Steven J Linton
- Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Michael Nicholas
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Kent
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Abstract
BACKGROUND Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs. OBJECTIVES The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments. SEARCH METHODS We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update. SELECTION CRITERIA We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration. DATA COLLECTION AND ANALYSIS Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo. MAIN RESULTS We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias. Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups. AUTHORS' CONCLUSIONS We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.
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Affiliation(s)
- Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Jenna Ellis
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Rachel Ogilvie
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Antti Malmivaara
- Centre for Health and Social Economics (CHESS), National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands
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Draper-Rodi J, Vogel S, Bishop A. Effects of an e-learning programme on osteopaths' back pain attitudes: a mixed methods feasibility study. Pilot Feasibility Stud 2021; 7:174. [PMID: 34517916 PMCID: PMC8436454 DOI: 10.1186/s40814-021-00901-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The biopsychosocial model is recommended in the management of non-specific low back pain but musculoskeletal practitioners can lack skills in assessing and managing patients using a biopsychosocial framework. Educational interventions have produced equivocal results. There is a need for an alternative educational tool to support practitioners' development in the application of biopsychosocial model to manage low back pain. METHODS A mixed methods study assessed the feasibility and acceptability of an e-learning programme on the biopsychosocial management of non-specific low back pain for osteopaths with more than 15 years' experience. A sequential explanatory design was conducted, with a feasibility randomised controlled trial and semi-structured interviews explored with thematic analysis. RESULTS A total of 45 participants participated in the RCT of which 9 also participated in the interview study. The a-priori sample size was not met (45 instead of 50). The recruitment strategies, randomisation, retention, data collection and outcome measures worked well and were found to be feasible for a main trial. The retention, satisfaction and participants' views of the programme demonstrated a good acceptability of the programme. Data from the semi-structured interviews were organised in three themes, the first two were related to the feasibility and acceptability of the e-learning programme (practical experience of following the course and engagement with the content) and the third relates to the impact of the intervention (perception of the BPS model). CONCLUSION A main RCT is feasible and the intervention was received well by the participants. A main RCT is required to assess the effectiveness of the e-learning programme. This work also provided data on aspects so far unreported, including osteopaths' views on continuing professional development, on e-learning as a form of continuing professional development and osteopaths' perceptions and challenges concerning the implementation of the biopsychosocial model in practice.
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Affiliation(s)
- Jerry Draper-Rodi
- University College of Osteopathy, 275 Borough High Street, London, SE1 1JE UK
| | - Steven Vogel
- University College of Osteopathy, 275 Borough High Street, London, SE1 1JE UK
| | - Annette Bishop
- Arthritis Research UK Primary Care Centre, Research Institute Primary Care Sciences, Keele University, Staffordshire, ST5 5BG UK
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Lynch TS, Oak SR, Cossell C, Strnad G, Zajichek A, Goodwin R, Jones MH, Spindler KP, Rosneck J. Effect of Baseline Mental Health on 1-Year Outcomes After Hip Arthroscopy: A Prospective Cohort Study. Orthop J Sports Med 2021; 9:23259671211025526. [PMID: 34485585 PMCID: PMC8414618 DOI: 10.1177/23259671211025526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Patient factors, including mental health, sex, and smoking, have been found
to be more predictive of preoperative hip pain and function than
intra-articular findings during hip arthroscopy for femoroacetabular
impingement (FAI); however, little is known about how these factors may
influence patients’ postoperative outcomes. Hypothesis: We hypothesized that lower patient-reported mental health scores would be
significant risk factors for worse patient-reported outcomes (PROs) 1 year
after arthroscopic hip surgery for FAI and that baseline intra-articular
pathology would fail to demonstrate an association with outcomes 1 year
after FAI surgery. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort of patients undergoing hip arthroscopy for FAI were
electronically enrolled. Baseline and 1-year follow-up PROs were collected,
including Hip disability and Osteoarthritis Outcome Score for pain
(HOOS-Pain), HOOS–Physical Function Short Form (HOOS-PS), and Veterans RAND
12-Item Health Survey–Mental Component Score (VR-12 MCS). Intra-articular
operative findings and treatment were documented at the time of surgery.
Proportional odds logistic regression models were built for 1-year outcomes
(HOOS-Pain, HOOS-PS, and VR-12 MCS). Risk factors included patient
characteristics and intraoperative anatomic and pathologic findings. Results: Overall, 494 patients underwent hip arthroscopy for FAI, and 385 (78%) were
evaluated at 1 year with at least 1 PRO. The median patient age was 33
years, mean body mass index was 25.5 kg/m2, and 72% were female.
Multivariable analysis demonstrated that better baseline HOOS-Pain, HOOS-PS,
and VR-12 MCS were significantly associated with improvement in the 1-year
scores for each PRO. Higher VR-12 MCS was significantly associated with
better 1-year HOOS-Pain and HOOS-PS, while current and former smokers had
worse 1-year outcomes than those who never smoked. In ranking each
variable’s relative importance, baseline HOOS-Pain and HOOS-PS and baseline
VR-12 MCS were identified as the strongest predictors of 1-year HOOS-Pain
and HOOS-PS in our multivariable model. Conclusion: During hip arthroscopy for FAI, patient factors, including baseline hip pain
and function, mental health, and smoking, were independently associated with
1-year PROs of hip pain and function, while intra-articular pathology such
as the presence of labral tear and its treatment, tear size, tear location,
and anchors placed were not independently associated.
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Affiliation(s)
- T Sean Lynch
- Columbia University Irving Medical Center, New York, New York, USA
| | - Sameer R Oak
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | | | | - Alexander Zajichek
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio, USA
| | - Ryan Goodwin
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | | | | - James Rosneck
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
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Pain and Disability in Low Back Pain Can be Reduced Despite No Significant Improvements in Mechanistic Pain Biomarkers. Clin J Pain 2021; 37:330-338. [PMID: 33830092 DOI: 10.1097/ajp.0000000000000927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/28/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Altered balance in nociception in response to noxious stimuli is commonly reported in chronic low back pain (LBP). However, it is unclear whether an improvement in the clinical presentation is contingent on a reduction in pain sensitivity. This study investigated whether the quantitative sensory testing (QST) profile changes in people undergoing rehabilitation for LBP. DESIGN A prospective, observational case-control study. METHODS Forty males and females, 18 to 40 years' old (20 with LBP) participated in 2 sessions. QST was performed at baseline and after discharge from rehabilitation (LBP) or after 3 to 8 weeks (controls). The QST battery consisted of determining pressure-pain thresholds at the low back and shoulder, temporal summation of pain, and conditioned pain modulation. Questionnaire data was used to determine pain (Numeric Rating Scale [NRS]), disability (Roland-Morris Questionnaire [RMQ]), Fear Avoidance Beliefs (FABQ), and The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) at baseline and discharge. The treatment effect was determined by calculating the Cohen d. RESULTS No significant group×time interactions or main factor effect was found for any of the QST measures. The LBP group reported a significant reduction in NRS (P<0.0002, d=1.23), RMQ (P<0.0001, d=1.58), FABQ (P<0.001, d=0.87), and in the ÖMPSQ (P<0.00001, d=1.44). CONCLUSIONS The results indicate that an improvement of clinical LBP is not contingent upon changes in the pain sensory profile. The value of screening pain sensitivity in LBP patients in primary care, needs to be investigated further, due to the patient population heterogeneity and the sensitivity of assessment methods.
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65
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Vanti C, Ferrari S, Guccione AA, Pillastrini P. Lumbar spondylolisthesis: STATE of the art on assessment and conservative treatment. Arch Physiother 2021; 11:19. [PMID: 34372944 PMCID: PMC8351422 DOI: 10.1186/s40945-021-00113-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/21/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is weak relationship between the presence of lumbar spondylolisthesis [SPL] and low back pain that is not always associated with instability, either at the involved lumbar segment or at different spinal levels. Therefore patients with lumbar symptomatic SPL can be divided into stable and unstable, based on the level of mobility during flexion and extension movements as general classifications for diagnostic and therapeutic purposes. Different opinions persist about best treatment (conservative vs. surgical) and among conservative treatments, on the type, dosage, and progression of physical therapy procedures. PURPOSE AND IMPORTANCE TO PRACTICE The aim of this Masterclass is to provide clinicians evidence-based indications for assessment and conservative treatment of SPL, taking into consideration some subgroups related to specific clinical presentations. CLINICAL IMPLICATIONS This Masterclass addresses the different phases of the assessment of a patient with SPL, including history, imaging, physical exam, and questionnaires on disability and cognitive-behavioral components. Regarding conservative treatment, self- management approaches and graded supervised training, including therapeutic relationships, information and education, are explained. Primary therapeutic procedures for pain control, recovery of the function and the mobility through therapeutic exercise, passive mobilization and antalgic techniques are suggested. Moreover, some guidance is provided on conservative treatment in specific clinical presentations (lumbar SPL with radiating pain and/or lumbar stenosis, SPL complicated by other factors, and SPL in adolescents) and the number/duration of sessions. FUTURE RESEARCH PRIORITIES Some steps to improve the diagnostic-therapeutic approach in SPL are to identify the best cluster of clinical tests, define different lumbar SPL subgroups, and investigate the effects of treatments based on that classification, similarly to the approach already proposed for non-specific LBP.
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Affiliation(s)
- Carla Vanti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Silvano Ferrari
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Andrew A. Guccione
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA 22030 USA
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
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66
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Gjefsen E, Gervin K, Goll G, Bråten LCH, Wigemyr M, Aass HCD, Vigeland MD, Schistad E, Pedersen LM, Pripp AH, Storheim K, Selmer KK, Zwart JA. Macrophage migration inhibitory factor: a potential biomarker for chronic low back pain in patients with Modic changes. RMD Open 2021; 7:rmdopen-2021-001726. [PMID: 34344830 PMCID: PMC8336134 DOI: 10.1136/rmdopen-2021-001726] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/19/2021] [Indexed: 01/20/2023] Open
Abstract
Background Low back pain (LBP) is a leading cause of disability worldwide, but the aetiology remains poorly understood. Finding relevant biomarkers may lead to better understanding of disease mechanisms. Patients with vertebral endplate bone marrow lesions visualised on MRI as Modic changes (MCs) have been proposed as a distinct LBP phenotype, and inflammatory mediators may be involved in the development of MCs. Objectives To identify possible serum biomarkers for LBP in patients with MCs. Methods In this case control study serum levels of 40 cytokines were compared between patients with LBP and MC type 1 (n=46) or type 2 (n=37) and healthy controls (n=50). Results Analyses identified significantly higher levels of six out of 40 cytokines in the MC type 1 group (MC1), and five in the MC type 2 group (MC2) compared with healthy controls. Six cytokines were moderately correlated with pain. Principal component analyses revealed clustering and separation of patients with LBP and controls, capturing 40.8% of the total variance, with 10 cytokines contributing to the separation. Macrophage migration inhibitory factor (MIF) alone accounted for 92% of the total contribution. Further, receiver operating characteristics analysis revealed that MIF showed an acceptable ability to distinguish between patients and controls (area under the curve=0.79). Conclusions These results suggest that cytokines may play a role in LBP with MCs. The clinical significance of the findings is unknown. MIF strongly contributed to clustering of patients with LBP with MCs and controls, and might be a biomarker for MCs. Ultimately, these results may guide future research on novel treatments for this patient group.
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Affiliation(s)
- Elisabeth Gjefsen
- Communication and Research Unit for Musculoskeletal Disorders, Oslo universitetssykehus Ulleval, Oslo, Norway .,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristina Gervin
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Guro Goll
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Monica Wigemyr
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | | | - Maria Dehli Vigeland
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Elina Schistad
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology Research Support Services, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Disorders, Oslo universitetssykehus Ulleval, Oslo, Norway.,Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | | | - John Anker Zwart
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
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67
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McPhee ME, Graven-Nielsen T. Medial Prefrontal High-Definition Transcranial Direct Current Stimulation to Improve Pain Modulation in Chronic Low Back Pain: A Pilot Randomized Double-blinded Placebo-Controlled Crossover Trial. THE JOURNAL OF PAIN 2021; 22:952-967. [PMID: 33676009 DOI: 10.1016/j.jpain.2021.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
Chronic low back pain (CLBP) is highly disabling, but often without identifiable source. Focus has been on impaired anti-nociceptive mechanisms contributing to pain maintenance, though methods of targeting this impairment remain limited. This randomised-controlled cross-over pilot trial used active versus sham medial prefrontal cortex (mPFC) high-definition transcranial direct current stimulation (HD-tDCS) for 3-consecutive days to improve descending pain inhibitory function. Twelve CLBP patients were included with an average visual analogue scale (VAS) pain intensity of 3.0 ± 1.5 and pain duration of 5.3 ± 2.6 years. Pressure pain thresholds (PPTs), conditioned pain modulation (CPM), and temporal summation of pain (TSP) assessed by cuff algometry, as well as pain symptomatology (intensity, unpleasantness, quality, disability) and related psychological features (pain catastrophizing, anxiety, affect), were assessed on Day1 before 3 consecutive days of HD-tDCS sessions (each 20 minutes), at 24-hours (Day 4) and 2-weeks (Day 21) following final HD-tDCS. Blinding was successful. No significant differences in psychophysical (PPT, CPM, TSP), symptomatology or psychological outcomes were observed between active and sham HD-tDCS on Day4 and Day21. CPM-effects at Day 1 negatively correlated with change in CPM-effect at Day4 following active HD-tDCS (P = .002). Lack of efficacy was attributed to several factors, not least that patients did not display impaired CPM at baseline. TRIAL REGISTRATION: : ClinicalTrials.gov (NCT03864822). PERSPECTIVE: Medial prefrontal HD-tDCS did not alter pain, psychological nor psychophysical outcomes, though correlational analysis suggested response may depend on baseline pain inhibitory efficacy, with best potential effects in patients with severe impairments in descending pain inhibitory mechanisms. Future work should focus on appropriate patient selection and optimising stimulation targeting.
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Affiliation(s)
- Megan E McPhee
- Center for Neuroplasticity and Pain (CNAP), Aalborg University, Denmark
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68
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Barbari V, Storari L, Maselli F, Testa M. Applicability of pain neuroscience education: Where are we now? J Back Musculoskelet Rehabil 2021; 34:511-520. [PMID: 33749636 DOI: 10.3233/bmr-200091] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Explaining pain to patients through pain neuroscience education (PNE) is currently a widespread treatment studied in the musculoskeletal context. Presently, there is sufficient evidence supporting the effectiveness of PNE in patients with chronic musculoskeletal disorders. However, clinicians must pay attention to the actual possibility to transfer research findings in their specific clinical context. OBJECTIVE We analysed the applicability of results of studies focused on PNE, which has not been done previously. METHODS A detailed discussion on PNE applicability is provided, starting from published randomized controlled trials that investigated the effectiveness of PNE. RESULTS This paper markedly points out the awareness of clinicians on the need for an accurate contextualization when choosing PNE as an intervention in clinical practice.
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69
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Filipczyk P, Filipczyk K, Saulicz E. Influence of Stabilization Techniques Used in the Treatment of Low Back Pain on the Level of Kinesiophobia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126393. [PMID: 34199155 PMCID: PMC8296215 DOI: 10.3390/ijerph18126393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 01/01/2023]
Abstract
The aim of this study was to try to compare the effectiveness of manual therapy techniques in combination with stabilization techniques: the so-called Australian method and the Neurac method in relation to pain sensations and the level of kinesiophobia. A total of 69 people were examined, divided into three groups of 23 people each. The Visual Analogue Scale was used to assess the antalgic effect, and the Kinesiophobia Causes Scale questionnaire was used to assess the level of kinesiophobia. Patients improved over four weeks, during which they were assessed three times. The evaluation of the desired parameters was also performed over a 24-week period to assess long-term performance. Stabilization techniques are an effective extension of manual therapy techniques in patients with low back pain. People in the groups additionally improved in terms of stabilization techniques, which are characterized by a lower level of kinesiophobia. Its lowest level was found in the group additionally improved with the Neurac method. In the long-term study, the level of kinesiophobia in this group was still maintained at a reduced level. The use of stabilization techniques involving patients in action may significantly affect the level of kinesiophobia, and thus have a much wider effect than just pain reduction.
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Affiliation(s)
- Przemysław Filipczyk
- Faculty of Health Sciences, Jan Długosz University in Czestochowa, 42-200 Czestochowa, Poland
- Correspondence: ; Tel.: +48-34-365-59-83
| | - Karolina Filipczyk
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 42-612 Katowice, Poland;
| | - Edward Saulicz
- Departhment of Kinesiotheraphy and Special Methods in Physiotheraphy, The Physical Education Academy Jerzy Kukuczka in Katowice, 40-065 Katowice, Poland;
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70
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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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71
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Christe G, Darlow B, Pichonnaz C. Changes in physiotherapy students' beliefs and attitudes about low back pain through pre-registration training. Arch Physiother 2021; 11:13. [PMID: 33993879 PMCID: PMC8126429 DOI: 10.1186/s40945-021-00106-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Implementation of best-practice care for patients with low back pain (LBP) is an important issue. Physiotherapists' who hold unhelpful beliefs are less likely to adhere to guidelines and may negatively influence their patients' beliefs. Pre-registration education is critical in moving towards a biopsychosocial model of care. This study aimed to investigate the changes in 2nd year physiotherapy students' beliefs about LBP after a module on spinal pain management and determine whether these changes were maintained at the end of academic training. METHODS During three consecutive calendar years, this longitudinal cohort study assessed physiotherapy students' beliefs with the Back Pain Attitudes Questionnaires (Back-PAQ) in their 1st year, before and after their 2nd year spinal management learning module, and at the end of academic training (3rd year). Unpaired t-tests were conducted to explore changes in Back-PAQ score. RESULTS The mean response rate after the spinal management module was 90% (128/143 students). The mean (± SD) Back-PAQ score was 87.73 (± 14.21) before and 60.79 (± 11.44) after the module, representing a mean difference of - 26.95 (95%CI - 30.09 to - 23.80, p < 0.001). Beliefs were further improved at the end of 3rd year (- 7.16, 95%CI - 10.50 to - 3.81, p < 0.001). CONCLUSIONS A spinal management learning module considerably improved physiotherapy students' beliefs about back pain. Specifically, unhelpful beliefs about the back being vulnerable and in need of protection were substantially decreased after the module. Improvements were maintained at the end of academic training one-year later. Future research should investigate whether modifying students' beliefs leads to improved clinical practice in their first years of practice.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Claude Pichonnaz
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
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Vaegter HB, Johansen JV, Sopina L, Smith A, Kent P, Fuglsang KS, Pedersen JF, Schutze R, O’Sullivan P, Handberg G, Fatoye F, Ussing K, Stegemejer I, Thorlund JB. A Cognitive Functional Therapy+ Pathway Versus an Interdisciplinary Pain Management Pathway for Patients With Severe Chronic Low Back Pain (CONFeTTI Trial): Protocol for a Pragmatic Randomized Controlled Trial. Phys Ther 2021; 101:6277052. [PMID: 34003285 PMCID: PMC8427714 DOI: 10.1093/ptj/pzab132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/26/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Chronic low back pain (cLBP) is the leading cause of disability. Interdisciplinary pain management is recommended for patients with severe/high-impact cLBP. Such programs are expensive, not easily accessible, and have limited effect; therefore, new cost-effective strategies are warranted. Cognitive functional therapy (CFT) has shown promising results but has not been compared with an interdisciplinary pain management approach. The primary aim of this randomized controlled trial is to investigate if a pathway starting with CFT including psychologist support (CFT+) with the option of additional usual care (if needed) is superior in improving disability and more cost-effective at 12 months compared with an interdisciplinary pain management pathway (usual care). METHODS This pragmatic, 2-arm, parallel-group randomized controlled trial will randomly allocate patients (n = 176) aged 18 to 75 years referred to an interdisciplinary pain center due to severe cLBP to 1 of 2 groups (1:1 ratio). Participants randomized to CFT+ will participate in a 3-month functional rehabilitation pathway with the option of additional usual care (if needed), and participants randomized to the interdisciplinary pain management pathway will participate in an individualized program of longer duration designed to best suit the individual's situation, needs, and resources. The primary outcome is the proportion of participants with an 8-point improvement in the Oswestry Disability Index score at 12 months. Exploratory outcomes are change in Oswestry Disability Index scores over time and an economic analysis of quality-adjusted life years using the 3-level version of the EuroQol EQ-5D. IMPACT The study evaluates the cost-effectiveness of CFT+ with the option of additional usual care (if needed) for individuals with severe cLBP. Findings can potentially improve future care pathways and reduce cost for the health care system.
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Affiliation(s)
- Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark,Address all correspondence to Dr Bjarke Vaegter at:
| | | | - Liza Sopina
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark,Danish Centre for Health Economics, DaCHE, Dept. of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Peter Kent
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia,Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | | | - Rob Schutze
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Peter O’Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Gitte Handberg
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark,Pain Center, Odense University Hospital, Odense, Denmark
| | - Francis Fatoye
- Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Kasper Ussing
- Spine Center of Southern Denmark, Hospital of Lillebaelt, Middelfart, Denmark
| | - Irene Stegemejer
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark
| | - Jonas Bloch Thorlund
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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73
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Ussing K, Kjaer P, Smith A, Kent P, Jensen RK, Schiøttz-Christensen B, O'Sullivan PB. Cognitive Functional Therapy for People with Nonspecific Persistent Low Back Pain in a Secondary Care Setting-A Propensity Matched, Case-Control Feasibility Study. PAIN MEDICINE 2021; 21:2061-2070. [PMID: 32221554 DOI: 10.1093/pm/pnaa034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Effective, inexpensive, and low-risk interventions are needed for patients with nonspecific persistent low back pain (NS-PLBP) who are unresponsive to primary care interventions. Cognitive functional therapy (CFT) is a multidimensional behavioral self-management approach that has demonstrated promising results in primary care and has not been tested in secondary care. OBJECTIVE To investigate the effect of CFT and compare it with usual care for patients with NS-PLBP. DESIGN Case-control study. SETTING A secondary care spine center. SUBJECTS Thirty-nine patients received a CFT intervention and were matched using propensity scoring to 185 control patients receiving usual care. METHODS The primary outcome was Roland Morris Disability Questionnaire (0-100 scale) score. Group-level differences at six- and 12-month follow-up were estimated using mixed-effects linear regression. RESULTS At six-month follow-up, a statistically significant and clinically relevant difference in disability favored the CFT group (-20.7, 95% confidence interval [CI] = -27.2 to -14.2, P < 0.001). Significant differences also occurred for LBP and leg pain, fear, anxiety, and catastrophizing in favor of CFT. At 12-month follow-up, the difference in disability was smaller and no longer statistically significant (-8.1, 95% CI = -17.4 to 1.2, P = 0.086). Differences in leg pain intensity and fear remained significantly in favor of CFT. Treatment satisfaction was significantly higher in the CFT group at six- (93% vs 66%) and 12-month (84% vs 52%) follow-up. CONCLUSIONS These findings support that CFT is beneficial for patients with NS-PLBP who are unresponsive to primary care interventions. Subsequent randomized controlled trials could incorporate booster sessions, which may result in larger effects at 12-month follow-up.
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Affiliation(s)
- Kasper Ussing
- Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark.,Spine & Mind Fysio, Dalum, Odense, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Health Research Centre, University College Lillebaelt, Odense, Denmark.,Department of Applied Health Services, University College Lillebaelt, Odense M, Denmark
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Australia
| | - Peter Kent
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Health Research Centre, University College Lillebaelt, Odense, Denmark.,School of Physiotherapy and Exercise Science, Curtin University, Australia
| | - Rikke K Jensen
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Health Research Centre, University College Lillebaelt, Odense, Denmark
| | - Berit Schiøttz-Christensen
- Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark.,Department of Regional Health Research, Faculty of Health Services, University of Southern Denmark, Odense, Denmark
| | - Peter Bruce O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Australia.,Body Logic Physiotherapy Clinic, Perth, Australia
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Bain KA, Hoch MC, Kosik KB, Gribble PA, Hoch JM. Psychological impairments in individuals with history of ankle sprain: a systematic review. Physiother Theory Pract 2021; 38:1889-1907. [PMID: 33896345 DOI: 10.1080/09593985.2021.1920079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patient-reported outcomes (PROs) can be used to assess and monitor psychological health following musculoskeletal injury. Studies have reported decreased psychological health after lateral ankle sprain (LAS) using numerous PROs. The purpose of this systematic review was to critically evaluate individual studies, summarize PROs utilized to quantify psychological health, and examine the effect of ankle injury on psychological health between groups (1 LAS, >1 LAS, and healthy controls). Databases searched included: CINAHL, MEDLINE, SPORTDiscus, APA, Psychinfo and PubMed Central. All case-control studies were critically appraised using the modified Downs and Black. Effect sizes (ES) were calculated between the groups (1 LAS, >1 LAS, healthy control) for each of the identified studies, for each included PRO used to quantify psychological impairments. Nine high-quality manuscripts were included. Overall, individuals with history of > 1 LAS self-reported greater psychological impairments compared to healthy controls (ES range = -0.37-12.16), while those with 1 LAS had similar psychological health to healthy control groups (ES rang e = -0.65-0.65). Conclusion: The main findings from this systematic review were individuals with > 1 LAS have increased levels of injury-related fear and decreased psychological health compared to healthy controls. PROs can aid clinicians in identifying psychological health concerns during rehabilitation.
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Affiliation(s)
- Katherine A Bain
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Matthew C Hoch
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Kyle B Kosik
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Phillip A Gribble
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Johanna M Hoch
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
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Korakakis V, O’Sullivan K, Kotsifaki A, Sotiralis Y, Giakas G. Lumbo-pelvic proprioception in sitting is impaired in subgroups of low back pain-But the clinical utility of the differences is unclear. A systematic review and meta-analysis. PLoS One 2021; 16:e0250673. [PMID: 33901255 PMCID: PMC8075231 DOI: 10.1371/journal.pone.0250673] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 04/08/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Altered spinal postures and altered motor control observed among people with non-specific low back pain have been associated with abnormal processing of sensory inputs. Evidence indicates that patients with non-specific low back pain have impaired lumbo-pelvic proprioceptive acuity compared to asymptomatic individuals. OBJECTIVE To systematically review seated lumbo-pelvic proprioception among people with non-specific low back pain. METHODS Five electronic databases were searched to identify studies comparing lumbo-pelvic proprioception using active repositioning accuracy in sitting posture in individuals with and without non-specific low back pain. Study quality was assessed by using a modified Downs and Black's checklist. Risk of bias was assessed using an adapted tool for cross-sectional design and case-control studies. We performed meta-analysis using a random effects model. Meta-analyses included subgroup analyses according to disability level, directional subgrouping pattern, and availability of vision during testing. We rated the quality of evidence using the GRADE approach. RESULTS 16 studies met the eligibility criteria. Pooled meta-analyses were possible for absolute error, variable error, and constant error, measured in sagittal and transverse planes. There is very low and low certainty evidence of greater absolute and variable repositioning error in seated tasks among non-specific low back pain patients overall compared to asymptomatic individuals (sagittal plane). Subgroup analyses indicate moderate certainty evidence of greater absolute and variable error in seated tasks among directional subgroups of adults with non-specific low back pain, along with weaker evidence (low-very low certainty) of greater constant error. DISCUSSION Lumbo-pelvic proprioception is impaired among people with non-specific low back pain. However, the low certainty of evidence, the small magnitude of error observed and the calculated "noise" of proprioception measures, suggest that any observed differences in lumbo-pelvic proprioception may be of limited clinical utility. PROSPERO-ID CRD42018107671.
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Affiliation(s)
- Vasileios Korakakis
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Faculty of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
- Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece
- * E-mail:
| | - Kieran O’Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, University of Limerick, Limerick, Ireland
| | | | - Yiannis Sotiralis
- Faculty of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Giannis Giakas
- Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece
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76
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Ryynänen K, Oura P, Simula AS, Holopainen R, Paukkunen M, Lausmaa M, Remes J, Booth N, Malmivaara A, Karppinen J. Effectiveness of training in guideline-oriented biopsychosocial management of low-back pain in occupational health services - a cluster randomized controlled trial. Scand J Work Environ Health 2021; 47:367-376. [PMID: 33847366 PMCID: PMC8259706 DOI: 10.5271/sjweh.3959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: This study aimed to investigate the effectiveness of brief training in the guideline-oriented biopsychosocial management of low-back pain (LBP) in occupational health services using a cluster-randomized design. A small sample of physiotherapists and physicians from the intervention units (N=12) were given three- to seven-day training focusing on the biopsychosocial management of LBP, while professionals in the control units (N=15) received no such training. Methods: Eligible patients with LBP, with or without radicular pain, aged 18–65, were invited to participate. A web-based questionnaire was sent to all recruited patients at baseline, three months and one year. The primary outcome measure was disability (Oswestry Disability Index, ODI) over one year. Between-group differences were analyzed using linear and generalized linear mixed models adjusted for baseline-response delay as well as variables showing between-group imbalance at baseline. Results: The final study sample comprised 234 and 81 patients in the intervention and control groups, respectively at baseline, and 137 and 47 patients, respectively, at one year. At baseline, the mean duration of pain was longer in the intervention group (P=0.017), and pain-related fear concerning physical activity was lower (P=0.012). We observed no significant difference between the groups’ primary outcome measure (adjusted one-year mean difference in the ODI: 2.3; 95% confidence interval -1.0–5.7; P=0.175) or most secondary outcomes. Conclusions: Brief training in guideline-oriented biopsychosocial management of LBP for occupational health professionals did not appear to be effective in reducing patients’ symptom over one-year follow-up compared to treatment as usual.
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Affiliation(s)
- Katja Ryynänen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
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Jassi FJ, Del Antônio TT, Azevedo BO, Moraes R, George SZ, Chaves TC. Star-Shape Kinesio Taping Is Not Better Than a Minimal Intervention or Sham Kinesio Taping for Pain Intensity and Postural Control in Chronic Low Back Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:1352-1360.e3. [PMID: 33819489 DOI: 10.1016/j.apmr.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study investigated the effects of star-shape Kinesio taping (KT) compared with both sham KT and minimal intervention (MI) on pain intensity and postural control. DESIGN Randomized controlled trial. SETTING Outpatient physical therapy. PARTICIPANTS A total of 120 people with chronic low back pain (CLBP) aged 18-60 years (N=120). INTERVENTIONS Star-shape KT, sham KT (no tension), and MI (educational booklet for self-management counseling). MAIN OUTCOME MEASURES The primary outcome measures were pain intensity and center of pressure (COP) mean sway speed, and disability score (Oswestry Disability Index) was a secondary outcome. The outcomes were obtained immediately after initial KT application, on the seventh day of intervention and at the 1-month follow-up. Linear mixed-model analyses using Bonferroni post hoc analyses were applied to investigate between-group differences. The model included treatment, time, and treatment×time interaction as fixed effects. RESULTS Pain intensity was significantly lower for the star-shape KT group than for the MI group (mean difference [MD], -1.35; 95% confidence interval [CI], -2.63 to -0.07) immediately after the intervention and on the seventh day of intervention (MD, -1.32; 95% CI, -2.56 to -0.07). No difference in pain intensity between star-shape KT vs sham-KT groups was observed. In addition, no significant between-group differences were observed for the COP mean sway speed and disability score at any of the follow-up times. CONCLUSIONS Our results showed no meaningful effect of star-shape KT intervention on pain intensity and postural control in people with CLBP compared with MI or sham KT. The observed reduction of 1.3 units between star-shape KT and MI groups was statistically different, but it could not be considered clinically relevant. The results of this trial suggest that benefits from KT are more likely attributable to contextual factors rather than specific taping parameters.
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Affiliation(s)
- Fabrício José Jassi
- Centre of Health Sciences, University of North Paraná, Jacarezinho, Paraná, Brazil; Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Tiago Tsunoda Del Antônio
- Centre of Health Sciences, University of North Paraná, Jacarezinho, Paraná, Brazil; Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Beatriz Oliveira Azevedo
- Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Renato Moraes
- Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Steven Z George
- Department of Orthopaedic Surgery and Therapeutic Area Lead for Musculoskeletal and Surgical Sciences, Duke University, Durham, NC
| | - Thais Cristina Chaves
- Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
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78
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Critically appraised paper: Cognitive functional therapy reduced disability compared with group-based exercise and education for chronic low back pain [commentary]. J Physiother 2021; 67:141. [PMID: 33744184 DOI: 10.1016/j.jphys.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/27/2021] [Indexed: 11/21/2022] Open
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Abstract
Purpose of Review Chronic pain is a widespread public and physical health crisis, as it is one of the most common reasons adults seek medical care and accounts for the largest medical reason for disability in the USA (Glombiewski et al., J Consult Clin Psychol. 86(6):533-545, 2018; Schemer et al., Eur J Pain. 23(3):526-538, 2019). Chronic pain is associated with decreased functional status, opioid dependence and substance abuse disorders, mental health crises, and overall lower perceived quality of life (Korff et al., J Pain. 17(10):1068-1080, 2016). For example, the leading cause of chronic pain and the leading cause of long-term disability is low back pain (LBP) (Bjorck-van Dijken et al. J Rehabil Med. 40:864–9, 2008). Evidence suggests that persistent low back pain (pLBP) is a multidimensional biopsychosocial problem with various contributing factors (Cherkin et al., JAMA. 315(12):1240-1249, 2016). Emotional distress, pain-related fear, and protective movement behaviors are all unhelpful lifestyle factors that previously were more likely to go unaddressed when assessing and treating patient discomfort (Pincus et al., Spine. 38:2118–23, 2013). Those that are not properly assisted with these psychosocial issues are often unlikely to benefit from treatment in the primary care setting and thus are referred to multidisciplinary pain rehabilitation physicians. This itself increases healthcare costs, and treatments can be invasive and have risks of their own. Therefore, less expensive and more accessible management strategies targeting these psychosocial issues should be started to facilitate improvement early. As a biopsychosocial disorder, chronic pain is influenced by a range of factors including lifestyle, mental health status, familial culture, and socioeconomic status. Physicians have moved toward multi-modal pain approaches in order to combat this public health dilemma, ranging from medications with several different mechanisms of action, lifestyle changes, procedural pain control, and psychological interventions (Fashler et al., Pain Res Manag. 2016:5960987, 2016). Part of the rehabilitation process now more and more commonly includes cognitive behavioral and cognitive functional therapy. Cognitive functional therapy (CFT) and cognitive behavioral therapy (CBT) are both multidimensional psychological approaches to combat the mental portion of difficult pain control. While these therapies are quite different in their approach, they lend to the idea that chronic pain can and should be targeted using coping mechanisms, helping patients understand the pathophysiological process of pain, and altering behavior. Recent Findings CFT differs from CBT functionally, as instead of improving managing/coping mechanisms of pain control from a solely mental approach, CFT directly points out maladaptive behaviors and actively challenges the patient to change them in a cognitively integrated, progressive overloading functional manner (Bjorck-van Dijken et al. J Rehabil Med. 40:864–9, 2008). This allows CFT to be targeted to each individual patient, with the goal of personalized reconceptualization of the pain response. The end goal is to overcome the barriers that prevent functional status improvement, a healthy lifestyle, and reaching their personal goals. Summary Chronic pain is a major public health issue. Cognitive functional therapy (CFT) and cognitive behavioral therapy (CBT) are both multidimensional psychological approaches to combat the mental portion of difficult pain control. While these therapies are quite different in their approach, they lend to the idea that chronic pain can and should be targeted using coping mechanisms, helping patients understand the pathophysiological process of pain, and altering behavior.
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80
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Zadro JR, Lewin AM, Kharel P, Naylor J, Maher CG, Harris IA. Physiotherapy utilisation and costs before lumbar spine surgery: a retrospective analysis of workers compensation claims in Australia. BMC Musculoskelet Disord 2021; 22:248. [PMID: 33676465 PMCID: PMC7937209 DOI: 10.1186/s12891-021-04129-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/28/2021] [Indexed: 01/07/2023] Open
Abstract
Background Understanding how much physiotherapy people receive before lumbar spine surgery could give insight into what people and clinicians consider an adequate trial of non-operative management. The aim of this study was to investigate physiotherapy utilisation and costs before lumbar spine surgery under a workers’ compensation claim in New South Wales (NSW), Australia. Methods Using data from the NSW State Insurance Regulatory Authority, we audited physiotherapy billing codes used before surgery for people who received lumbar spine surgery from 2010 to 2018. We summarised, separately for fusion and decompression, the time from initiation of physiotherapy to surgery, number of physiotherapy sessions people received before surgery, total cost of physiotherapy before surgery, and time from injury date to initiation of physiotherapy. All analyses were descriptive. Results We included 3070 people (800 had fusion, 2270 decompression). Mean age (standard deviation, SD) was similar between those who received fusion and decompression [42.9 (10.4) vs. 41.9 (11.6)]. Compared to people who had fusion, those who had decompression were more likely to not have any physiotherapy before surgery (28.4% vs. 15.4%), received physiotherapy for a shorter duration before surgery [median (interquartile range, IQR): 5 (3 to 11) vs. 15 (4–26) months], were less likely to have physiotherapy for ≥2 years before surgery (5.6% vs. 27.5%), had fewer physiotherapy sessions before surgery [mean (SD): 16 (21) vs. 28 (35) sessions], were less likely to have > 50 physiotherapy sessions before surgery (6.8% vs. 18.1%), and had lower total physiotherapy-related costs [mean (IQR): $1265 ($0–1808) vs. $2357 ($453–2947)]. Time from injury date to first physiotherapy session was similar between people who had fusion and decompression [median (IQR): 23 (9–66) vs.19 (7–53) days]. Conclusions There is variation in physiotherapy utilisation and costs before lumbar spine surgery for people funded by NSW Workers’ Compensation. Some people may not be receiving an adequate trial of physiotherapy before surgery, particularly before decompression surgery. Others may be receiving an excessive amount of physiotherapy before surgery, particularly before fusion. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04129-4.
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Affiliation(s)
- Joshua R Zadro
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.
| | - Adriane M Lewin
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Priti Kharel
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Orthopaedic Department, Liverpool Hospital, Sydney, NSW, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Ian A Harris
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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81
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Karppinen J, Simula AS, Holopainen R, Lausmaa M, Remes J, Paukkunen M, Ussing K, Booth N, Ryynänen K, Koski T, Abbott A, Öberg B, Linton SJ, Smith A, O'Sullivan P, Malmivaara A. Evaluation of training in guideline-oriented biopsychosocial management of low back pain in occupational health services: Protocol of a cluster randomized trial. Health Sci Rep 2021; 4:e251. [PMID: 33728382 PMCID: PMC7933561 DOI: 10.1002/hsr2.251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To prevent low back pain (LBP) from developing into a prolonged disabling condition, clinical guidelines advocate early stage assessment, risk-screening, and tailored interventions. Occupational health services recommend guideline-oriented biopsychosocial screening and individualized assessment and management. However, it is not known whether training a limited number of health care professionals improves the management process. The primary objective of this study is to investigate whether training in the biopsychosocial practice model is effective in reducing disability. Furthermore, we aim to evaluate health-economic impacts of the training intervention in comparison to usual medical care. METHODS The occupational health service units will be allocated into a training or control arm in a two-arm cluster randomized controlled design. The training of occupational physiotherapists and physicians will include the assessment of pain-related psychosocial factors using the STarT Back Tool and the short version of the Örebro Musculoskeletal Pain Screening Questionnaire, the use of an evidence-based patient education booklet as part of the management of LBP, and tailored individualized management of LBP according to risk stratification. The control units will receive no training. The study population will include patients aged 18-65 with nonspecific LBP. The primary outcome is a patient-reported Oswestry Disability Index from baseline to 12 months. By estimating group differences over time, we aim to evaluate the effectiveness of the training intervention in comparison to usual medical care, and to undertake an economic evaluation using individual patients' health care records (participant-level data) and the participating units' registries (cluster-level data). In addition, through interviews and questionnaires, we will explore the health care professionals' conceptions of the adoption of, the barriers to, and the facilitators of the implementation of the practice model. DISCUSSION The evaluation of training in the guideline-oriented biopsychosocial management of LBP in occupational health services is justified because LBP represents an enormous burden in terms of work disability.
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Affiliation(s)
- Jaro Karppinen
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
- Finnish Institute of Occupational HealthOuluFinland
| | - Anna Sofia Simula
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
- Department of General MedicineThe South Savo Social and Health Care AuthorityMikkeliFinland
| | - Riikka Holopainen
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | - Mikko Lausmaa
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Jouko Remes
- Finnish Institute of Occupational HealthOuluFinland
| | - Maija Paukkunen
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of PhysiotherapyLinköping UniversityLinköpingSweden
| | - Kasper Ussing
- Spine and Mind FysioOdenseDenmark
- Spine Center of Southern DenmarkLillebaelt HospitalMiddelfartDenmark
| | - Neill Booth
- Faculty of Social Sciences (Health Sciences)Tampere UniversityTampereFinland
| | - Katja Ryynänen
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
- Mehiläinen CorporationOuluFinland
| | - Tomi Koski
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
- Työterveys Virta OyOuluFinland
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of PhysiotherapyLinköping UniversityLinköpingSweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of PhysiotherapyLinköping UniversityLinköpingSweden
| | - Steven J. Linton
- Department of Law, Psychology, and Social Work, Center for Health and Medical PsychologyÖrebro UniversityÖrebroSweden
| | - Anne Smith
- School of Physiotherapy and Exercise ScienceCurtin UniversityPerthWestern AustraliaAustralia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise ScienceCurtin UniversityPerthWestern AustraliaAustralia
- Body Logic PhysiotherapyPerthWestern AustraliaAustralia
| | - Antti Malmivaara
- Centre for Health and Social EconomicsFinnish Institute for Health and WelfareHelsinkiFinland
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Nolan D, Sharpe N, O'Sullivan K, Stephenson J, O'Sullivan P, Lucock M. What are the back beliefs of NHS employees, and does manual handling training influence them. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1873417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- David Nolan
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Nicky Sharpe
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | | | - John Stephenson
- Department of Health Sciences, University of Huddersfield, Huddersfield, United Kingdom of Great Britain and Northern Ireland
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- Shenton Park, Body Logic Physiotherapy Clinic, Perth, Australia
| | - Mike Lucock
- Centre for Applied Research in Health, University of Huddersfield, Huddersfield, United Kingdom of Great Britain and Northern Ireland
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom of Great Britain and Northern Ireland
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Implementing a behavioral medicine approach in physiotherapy for patients with musculoskeletal pain: a scoping review. Pain Rep 2021; 5:e844. [PMID: 33490840 PMCID: PMC7808688 DOI: 10.1097/pr9.0000000000000844] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/11/2020] [Accepted: 07/07/2020] [Indexed: 01/24/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. The interventions in the scoping review were in agreement with the definition of behavioral medicine in physiotherapy, but reported behavior change techniques were few. In intervention research on musculoskeletal pain, physiotherapists often study behavioral and cognitive components. Evidence on applying these components has increased during the past decade. However, how to effectively integrate behavioral and cognitive components in the biopsychosocial management of musculoskeletal pain is challenging. The aim was to study the intervention components and patient outcomes of studies integrating behavioral and cognitive components in physiotherapy, to match the interventions with a definition of behavioral medicine in physiotherapy and to categorize the behavior change techniques targeted at patients with musculoskeletal pain in (1) randomized controlled effect trials or (2) implementation in clinical practice trials. A scoping review was used to conduct this study, and the PRISMA-ScR checklist was applied. Relevant studies were identified from the PubMed, MEDLINE, PsycINFO, CINAHL Plus, and Web of Science Core databases separately for the (1) randomized controlled effect trials and (2) implementation in clinical practice trials. Synthesis for the matching of the patient interventions with the existing definition of behavior medicine in physiotherapy showed that the interventions mostly integrated psychosocial, behavioral, and biomedical/physical aspects, and were thus quite consistent with the definition of behavioral medicine in physiotherapy. The reported behavior change techniques were few and were commonly in categories such as “information of natural consequences,” “feedback and monitoring,” and “goals and planning.” The patient outcomes for long-term follow-ups often showed positive effects. The results of this scoping review may inform future research, policies, and practice.
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Van Hoof W, O'Sullivan K, Verschueren S, O'Sullivan P, Dankaerts W. Evaluation of Absenteeism, Pain, and Disability in Nurses With Persistent Low Back Pain Following Cognitive Functional Therapy: A Case Series Pilot Study With 3-Year Follow-Up. Phys Ther 2021; 101:5904882. [PMID: 32949123 DOI: 10.1093/ptj/pzaa164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/06/2019] [Accepted: 08/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Persistent low back pain (PLBP) is a common and costly health problem worldwide. Better strategies to manage it are required. The purpose of this study was to longitudinally evaluate absenteeism, pain, and disability in nurses with PLBP following a cognitive functional therapy (CFT) intervention. METHODS In this case series pilot study, 33 eligible nurses with PLBP were recruited. During the baseline phase (phase A; no intervention), outcome measures were collected on 2 occasions 6 months apart (A1 and A2). During phase B, participants received an individualized CFT intervention for 14 weeks. During phase C (no intervention), outcomes were measured immediately after the intervention, as well as 3, 6, 9, 12, and 36 months after the intervention (secondary outcomes only until 12 months). LBP-related work absenteeism, pain intensity (numerical pain rating scale) and disability (Oswestry Disability Index) were the primary outcomes. Health care seeking, a range of psychological and lifestyle variables, and global perceived effect were secondary outcomes. RESULTS Days of absenteeism due to LBP were significantly reduced in the first and second calendar years after the CFT intervention but not the third and fourth. Disability was significantly reduced immediately after (-4.4; 95% CI = -6.5 to -2.2) and at 3 months (-4.3; 95% CI = -6.6 to -2.0), 9 months (-6.0; 95% CI = -8.1 to -3.9), and 12 months (-4.9; 95% CI = -7.0 to -2.8) after the intervention. Pain was significantly reduced immediately after (-1.2; 95% CI = -1.7 to -0.8) and at 3 months (-1.5; 95% CI = -2.0 to -0.9), 9 months (-1.1; 95% CI = -1.9 to -0.3), and 12 months (-0.9; 95% CI = -1.5 to -0.2) after the intervention. Total health care seeking (consults and proportion of participants) was significantly reduced after the intervention. All psychosocial variables, except for 1, demonstrated significant improvements at all follow-up assessments. CONCLUSIONS This case series pilot study demonstrated significant reductions in LBP-related absenteeism, pain intensity, disability, health care seeking, and several psychological and lifestyle behaviors until the 1-year follow-up among nurses with PLBP following an individualized CFT intervention. Further evaluation of the efficacy of CFT in high-quality randomized clinical trials among nurses is recommended.
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Affiliation(s)
- Wannes Van Hoof
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, B-3001 Leuven, Belgium
| | - Kieran O'Sullivan
- M Manip Ther, School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland, and Ageing Research Centre, Health, Research Institute, University of Limerick
| | - Sabine Verschueren
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, B-3001 Leuven, Belgium
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, B-3001 Leuven, Belgium
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85
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Kapitza C, Lüdtke K, Tampin B, Ballenberger N. Application and utility of a clinical framework for spinally referred neck-arm pain: A cross-sectional and longitudinal study protocol. PLoS One 2020; 15:e0244137. [PMID: 33370389 PMCID: PMC7769468 DOI: 10.1371/journal.pone.0244137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/02/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The clinical presentation of neck-arm pain is heterogeneous with varying underlying pain types (nociceptive/neuropathic/mixed) and pain mechanisms (peripheral/central sensitization). A mechanism-based clinical framework for spinally referred pain has been proposed, which classifies into (1) somatic pain, (2) neural mechanosensitivity, (3) radicular pain, (4) radiculopathy and mixed pain presentations. This study aims to (i) investigate the application of the clinical framework in patients with neck-arm pain, (ii) determine their somatosensory, clinical and psychosocial profile and (iii) observe their clinical course over time. METHOD We describe a study protocol. Patients with unilateral neck-arm pain (n = 180) will undergo a clinical examination, after which they will be classified into subgroups according to the proposed clinical framework. Standardized quantitative sensory testing (QST) measurements will be taken in their main pain area and contralateral side. Participants will have to complete questionnaires to assess function (Neck Disability Index), psychosocial factors (Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Depression, anxiety and stress scale), neuropathic pain (Douleur Neuropathique 4 Questions, PainDETECT Questionnaire) and central sensitization features (Central Sensitization Inventory). Follow-ups at three, six and 12 months include the baseline questionnaires. The differences of QST data and questionnaire outcomes between and within groups will be analyzed using (M)AN(C)OVA and/or regression models. Repeated measurement analysis of variance or a linear mixed model will be used to calculate the differences between three, six, and 12 months outcomes. Multiple regression models will be used to analyze potential predictors for the clinical course. CONCLUSION The rationale for this study is to assess the usability and utility of the proposed clinical framework as well as to identify possible differing somatosensory and psychosocial phenotypes between the subgroups. This could increase our knowledge of the underlying pain mechanisms. The longitudinal analysis may help to assess possible predictors for pain persistency.
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Affiliation(s)
- Camilla Kapitza
- Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Hochschule Osnabrueck, University of Applied Sciences, Osnabrueck, Germany
| | - Kerstin Lüdtke
- Department of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Luebeck, Germany
| | - Brigitte Tampin
- Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Hochschule Osnabrueck, University of Applied Sciences, Osnabrueck, Germany
- Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Physiotherapy and Exercises Sciences, Curtin University, Perth, Western Australia, Australia
| | - Nikolaus Ballenberger
- Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Hochschule Osnabrueck, University of Applied Sciences, Osnabrueck, Germany
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86
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Monticone M, Ambrosini E, Rocca B, Cazzaniga D, Liquori V, Lovi A, Brayda-Bruno M. Multimodal exercises integrated with cognitive-behavioural therapy improve disability of patients with failed back surgery syndrome: a randomized controlled trial with one-year follow-up. Disabil Rehabil 2020; 44:3422-3429. [PMID: 33356640 DOI: 10.1080/09638288.2020.1863480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the effect of multimodal exercises integrated with cognitive-behavioural therapy on disability, pain, and quality of life in patients suffering from failed back surgery syndrome (FBSS), and to appraise its extent in the long term. METHODS By means of a parallel-group superiority-controlled trial, 150 outpatients were randomly assigned to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after the end of treatment, the Oswestry Disability Index (primary outcome), the Tampa Scale for Kinesiophobia, the Pain Catastrophising Scale, a pain intensity numerical rating scale and the Short-Form Health Survey were evaluated. Linear mixed model analysis for repeated measures was carried out for each outcome measure. RESULTS Significant group (p < 0.001), time (p < 0.001), and time-by-group interaction (p < 0.001) effects were found for all outcome measures. Concerning disability, between-group differences (95% confidential interval) in favour of the experimental group of -9 (-10.7; -7.3) after training and of -13.2 (-14.7; -11.7) at follow-up were found. Also, kinesiophobia, catastrophising and pain showed significant between-group differences of 9, 12.5 and 1.7 points, respectively. CONCLUSION The multimodal intervention proposed was superior to general physiotherapy in reducing disability, kinesiophobia, catastrophising, and enhancing the quality of life of patients with FBSS. The effects were reinforced one year after the programme ended.IMPLICATIONS FOR REHABILITATIONMultimodal exercises integrated with cognitive-behavioural therapy induced significant improvements in disability, pain, kinesiophobia, catastrophising, and quality of life of subjects with Failed Back Surgery Syndrome.A well-integrated rehabilitative team which contributes towards reaching intervention goals is advised.Physiotherapists should adopt task-oriented exercises to promote an earlier return to common activities of disabled patients.Psychologists should explain how to modify useless beliefs and support adequate behaviours, in order to produce constructive attitudes towards perceived disability.
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Affiliation(s)
- Marco Monticone
- Physical Medicine and Rehabilitation, Department of Medical Sciences and Public Health, University of Cagliari.,Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy
| | - Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Barbara Rocca
- Physical Medicine and Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Italy
| | - Daniele Cazzaniga
- Physical Medicine and Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Italy
| | - Valentina Liquori
- Physical Medicine and Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Italy
| | - Alessio Lovi
- Unit of Spinal Orthopaedics Surgery, Galeazzi Hospital, IRRCS, Milan, Italy
| | - Marco Brayda-Bruno
- Unit of Spinal Orthopaedics Surgery, Galeazzi Hospital, IRRCS, Milan, Italy
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87
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Holopainen R, Vuoskoski P, Piirainen A, Karppinen J, O'Sullivan P. Patients' conceptions of undergoing physiotherapy for persistent low back pain delivered in Finnish primary healthcare by physiotherapists who had participated in brief training in cognitive functional therapy. Disabil Rehabil 2020; 44:3388-3399. [PMID: 33353430 DOI: 10.1080/09638288.2020.1861116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To explore the conceptions of patients with persistent low back pain (LBP) of undergoing physiotherapy delivered in Finnish primary healthcare by physiotherapists who had participated in brief training in Cognitive Functional Therapy (CFT). METHODS As part of a feasibility implementation study exploring CFT in management of LBP in the Finnish primary healthcare system, we interviewed nine patients from four geographical areas in Finland after receiving care. We used a phenomenographic approach to explore the variation in their conceptions. RESULTS The analysis revealed four descriptive categories: "hung out to dry," "stuck," "making sense and taking control," and "holistic approach to care and living," that varied based on six themes. CONCLUSIONS Although the participants accepted this approach to care well, there was significant variation in patients' conceptions. Restricted access to care within the healthcare system and a lack of social support led some of them to feel they had been left alone to suffer with their pain. On the other hand, based on the results of this study, positive experiences of physiotherapy and good collaboration with the physiotherapist, wider social support outside of physiotherapy, a better understanding of the multidimensional nature of pain and the acquisition of self-management skills were reported as positive aspects of undergoing physiotherapy that may be related to positive treatment outcomes.Implications for rehabilitationThe participants of this study saw undergoing physiotherapy delivered within biopsychosocial framework as different from their previous physiotherapy experiences and for some the process ended with feeling empty-handed and for others it could be a turning point in their lives.This study encourages the health care providers to create flexible care pathways and ongoing support for more vulnerable individuals so that they don't feel abandoned by the system.Professionals could also pay attention to building strong therapeutic alliance, help patients understand pain in biopsychosocial framework, take into consideration social support networks of the patients, and support patients toward effective self-management strategies.
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Affiliation(s)
- Riikka Holopainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Pirjo Vuoskoski
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland.,Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Bodylogic Physiotherapy, Perth, Australia
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Dragesund T, Nilsen RM, Kvåle A. Norwegian Psychomotor Physiotherapy versus Cognitive Patient Education and active physiotherapy-A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 26:e1891. [PMID: 33320397 DOI: 10.1002/pri.1891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 10/29/2020] [Accepted: 11/21/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE Norwegian Psychomotor Physiotherapy (NPMP) has been an established treatment approach for more than 50 years, mostly in the Scandinavian countries, usually applied to patients with widespread and long-lasting musculoskeletal pain and/or psychosomatic disorders. Few studies have investigated the outcomes of NPMP, and no randomized clinical trials (RCT) with a comparing treatment group have systematically been tried out on individuals. METHODS This is a pragmatic, single-blinded RCT where 128 participants with long-lasting widespread musculoskeletal pain and/or pain located to the neck and shoulders were block randomized to NPMP or Cognitive Patient Education combined with active individualized physiotherapy (COPE-PT). Intention-to-treat with linear mixed models were used to estimate the group differences in treatment effects. The outcomes at 3, 6, and 12 months follow-up were pain intensity, function, anxiety and depression, quality of life, sleep, fear of movement, and subjective health complaints. Risk profile (Örebro) was examined at 3 and 6 months. All participants underwent physical tests at baseline and 6 months. RESULTS One-year data were available for 66.4% of the original participants. Calculated with intention-to-treat analysis, at 3 months statistically significant differences were found in favor of COPE-PT for pain, anxiety and depression, quality of life-physical dimension, risk profile and fear of movement. At 6 months, statistically significant differences in favor of COPE-PT were found for anxiety and depression, and sleep. At 12 months, the improvements were still statistically significant for anxiety, depression and sleep. Both groups improved, but no statistically significant differences were found between the groups on the physical tests at 6 months. CONCLUSIONS COPE-PT, which is targeted towards pain-coping and increasing activity, contribute to more improvements than NPMP.
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Affiliation(s)
- Tove Dragesund
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Roy Miodini Nilsen
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Alice Kvåle
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Abstract
OBJECTIVE To investigate the relationship between changes in volitional spinal movement (including muscle activity) and changes in pain or activity limitation at the individual level in people with nonspecific low back pain. DESIGN Etiology systematic review. LITERATURE SEARCH MEDLINE, Embase, CINAHL, and AMED were searched from inception to January 2020. STUDY SELECTION CRITERIA The study included peer-reviewed articles that reported the relationship between changes in volitional spinal movement and changes in pain or activity limitation at the individual level in people with nonspecific low back pain. DATA SYNTHESIS The data were descriptively synthesized to identify a relationship between change in movement and improved pain or activity limitation. RESULTS We included 27 studies involving 2739 participants. There was low-quality evidence of a relationship between change in movement and change in pain or activity limitation at the individual level 31% of the time (20 of the 65 times investigated within the 27 studies). Increases in spinal range of motion, velocity, and flexion relaxation of the back extensors were consistently related to improved pain or activity limitation (93%, 18.5/20 relationships observed). CONCLUSION A relationship between changes in movement and changes in pain or activity limitation was infrequently observed at the individual level; however, a paucity of high-quality evidence precludes a definitive understanding of this relationship. J Orthop Sports Phys Ther 2020;50(12):664-680. Epub 28 Oct 2020. doi:10.2519/jospt.2020.9635.
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90
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Yu X, Convoy S, Singh PA, Png C, Yoong CS, Pal P. Early Experience of a Multidisciplinary Group Pain Program with Cognitive Behavioural Strategies, Physiotherapy and Peer Support for Patients with Chronic Noncancer Pain. Pain Manag Nurs 2020; 22:293-301. [PMID: 33250326 DOI: 10.1016/j.pmn.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic non-cancer pain affects about 20% of the population worldwide. The effect of medical treatment in isolation is often limited. A multidisciplinary approach has been strongly advocated to help manage patients' pain more effectively. AIMS The primary purpose was to reduce pain severity, pain interference on patients'daily activities and improve their levels of self-efficacy despite pain. The secondary aim was to evaluate the possible changes in patients' depression, anxiety, and stress symptoms after amultidisciplinary group pain program. The program content and structure were also evaluated. DESIGN This scholarly project used within-subject pre- and post-test design. SETTINGS/SUBJECTS Fifty-six patients were recruited from the project center pain clinic. METHODS An evidence-based eight-hour multidisciplinary group pain program was implemented. Data was collected before and 3 months after the program. INTERVENTIONS The program covered pain physiology, cognitive behavioural strategies, demonstration of various exercises, self-management skills, medication management, and peer support. RESULTS Three months postprogram, there was a statistically significant improvement in patients' pain severity (β = -0.9, 95% CI: -1.73 to -0.14, p = .023) and self-efficacy (β = 5.6, 95% CI: 0.85 to 10.41, p = .023). Pain interference on their daily activities was also significantly reduced (β = -2.0, 95% CI: -2.90 to -0.83, p = .001). Patients provided positive and encouraging feedback about the program. CONCLUSION Initial improvements in patients' ability to cope with pain and to perform daily activities were demonstrated following participation in the brief multidisciplinary group pain program. Future randomized controlled trials are needed to confirm that the results are due to patients' participation in the program.
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Affiliation(s)
- Xia Yu
- Department of Nursing Education, Changi General Hospital, Singapore.
| | - Sean Convoy
- Duke University School of Nursing, Durham, North Carolina
| | | | - Constance Png
- Department of Psychological Medicine, Changi General Hospital, Singapore
| | - Chee Seng Yoong
- Department of Anaesthesia, Changi General Hospital, Singapore
| | - Poonam Pal
- Rehabilitation Service, Changi General Hospital, Singapore
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Effects of a movement control and tactile acuity training in patients with nonspecific chronic low back pain and control impairment - a randomised controlled pilot study. BMC Musculoskelet Disord 2020; 21:794. [PMID: 33256694 PMCID: PMC7702711 DOI: 10.1186/s12891-020-03727-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/16/2020] [Indexed: 12/04/2022] Open
Abstract
Background Nonspecific chronic low back pain (NSCLBP) is a heterogeneous condition that is associated with complex neuromuscular adaptations. Exercise is a widely administered treatment, but its effects are small to moderate. Tailoring patient-specific exercise treatments based on subgroup classification may improve patient outcomes. Objective In this randomised controlled pilot study, our objective was to compare the feasibility and possible effects of a specific sensorimotor treatment (SMT) with those of a general exercise (GE) programme on patients with NSCLBP and control impairment (CI). Methods Patients with NSCLBP and CI were randomised into an SMT or a GE programme spanning 6 sessions each. The feasibility criteria included the study design, assessments, interventions and magnitudes of effects, and costs. Adverse events were documented. Primary (pain, physical function, and quality of life) and secondary outcomes were assessed three times: twice at baseline (t1a and t1b) to estimate parameter stability and once after the intervention (t2). Results Two-hundred and twenty-seven patients were screened to include 34 participants with NSCLBP and CI. Both treatment programmes and the assessments seemed feasible because their durations and contents were perceived as adequate. The total cost per participant was €321. Two adverse events occurred (one not likely related to the SMT, one likely related to the GE intervention). The SMT showed a tendency for superior effects in terms of pain severity (SMT t1a 3.5, t2 1.1; GE t1a 3.0, t2 2.0), pain interference (SMT t1a 1.9, t2 0.4; GE t1a 1.5, t2 0.9), physical component of quality of life (SMT t1a 39, t2 46; GE t1a 45, t2 48), and movement control. Conclusions The SMT approach proposed in this study is feasible and should be tested thoroughly in future studies, possibly as an addition to GE. To ensure the detection of differences in pain severity between SMT and GE in patients with NSCLBP with 80% power, future studies should include 110 patients. If the current results are confirmed, SMT should be considered in interventions for patients with NSCLBP and CI. Trial registration Registered in the German Register for Clinical Trials (Trial registration date: November 11, 2016; Trial registration number: DRKS00011063; URL of trial registry record); retrospectively registered.
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92
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De Wit M, Horreh B, Daams JG, Hulshof CTJ, Wind H, de Boer AGEM. Interventions on cognitions and perceptions that influence work participation of employees with chronic health problems: a scoping review. BMC Public Health 2020; 20:1610. [PMID: 33109123 PMCID: PMC7590449 DOI: 10.1186/s12889-020-09621-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/28/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cognitions and perceptions, such as motivation and return to work (RTW) expectations, can influence work participation of employees with chronic health problems. This makes these cognitions and perceptions important factors for occupational health professionals to intervene upon in order to increase work participation. There is, however, no overview of interventions that influence these factors and are aimed at increasing work participation. Therefore, the purpose of this scoping review is to explore available interventions that are focused on cognitions and perceptions of employees with chronic health problems and aimed at increasing work participation. METHODS A scoping review was carried out following the framework of Arksey and O'Malley. Ovid MEDLINE and PsycINFO were searched for original papers published between January 2013 and June 2020. We included studies that describe interventions that focus on at least one of ten cognitions and perceptions and on work participation. The risk of bias of the studies included was assessed using quality assessment tools from the Joanna Briggs Institute. RESULTS In total, 29 studies were identified that studied interventions aimed at changing at least one of ten cognitions and perceptions in order to change work participation. The interventions that were included mainly focused on changing recovery and RTW expectations, self-efficacy, feelings of control, perceived health, fear-avoidance beliefs, perceived work-relatedness of the health problem, coping strategies and catastrophizing. No interventions were found that focused on changing motivation or on optimism/pessimism. Four interventions were judged as effective in changing coping, self-efficacy, fear-avoidance beliefs, or perceived work-relatedness and work participation according to results of randomized controlled trials. CONCLUSIONS This review provides an overview of interventions that focus on changing cognitions and perceptions and work participation. Evidence was found for four effective interventions focused on changing these factors and increasing work participation. Occupational health professionals may use the overview of interventions to help employees with chronic health problems to increase their work participation.
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Affiliation(s)
- Mariska De Wit
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands.
| | - Bedra Horreh
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - Joost G Daams
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - Haije Wind
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - Angela G E M de Boer
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
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Gjefsen E, Bråten LCH, Goll GL, Wigemyr M, Bolstad N, Valberg M, Schistad EI, Marchand GH, Granviken F, Selmer KK, Froholdt A, Haugen AJ, Dagestad MH, Vetti N, Bakland G, Lie BA, Haavardsholm EA, Nilsen AT, Holmgard TE, Kadar TI, Kvien T, Skouen JS, Grøvle L, Brox JI, Espeland A, Storheim K, Zwart JA. The effect of infliximab in patients with chronic low back pain and Modic changes (the BackToBasic study): study protocol of a randomized, double blind, placebo-controlled, multicenter trial. BMC Musculoskelet Disord 2020; 21:698. [PMID: 33087100 PMCID: PMC7580023 DOI: 10.1186/s12891-020-03720-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Low back pain is common and a significant number of patients experience chronic low back pain. Current treatment options offer small to moderate effects. Patients with vertebral bone marrow lesions visualized as Modic changes on magnetic resonance imaging may represent a subgroup within the low back pain population. There is evidence for inflammatory mediators being involved in development of Modic changes; hence, suppression of inflammation could be a treatment strategy for these patients. This study examines the effect of anti-inflammatory treatment with the TNF-α inhibitor infliximab in patients with chronic low back pain and Modic changes. METHODS/DESIGN The BackToBasic trial is a multicenter, double blind, randomized controlled trial conducted at six hospitals in Norway, comparing intravenous infusions with infliximab with placebo. One hundred twenty-six patients aged 18-65 with chronic low back pain and type 1 Modic changes will be recruited from secondary care outpatients' clinics. The primary outcome is back pain-specific disability at day 154 (5 months). The study is designed to detect a difference in change of 10 (SD 18) in the Oswestry Disability Index at day 154/ 5 months. The study also aims to refine MRI-assessment, investigate safety and cost-effectiveness and explore the underlying biological mechanisms of Modic changes. DISCUSSION Finding treatments that target underlying mechanisms could pose new treatment options for patients with low back pain. Suppression of inflammation could be a treatment strategy for patients with low back pain and Modic changes. This paper presents the design of the BackToBasic study, where we will assess the effect of an anti-inflammatory treatment versus placebo in patients with chronic low back pain and type 1 Modic changes. The study is registered at ClinicalTrials.gov under the identifier NCT03704363 . The EudraCT Number: 2017-004861-29.
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Affiliation(s)
- Elisabeth Gjefsen
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital HF, Ulleval, Bygg 37b, P.O. Box 4956 Nydalen, 0424, Oslo, Norway. .,Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316, Oslo, Norway.
| | - Lars Christian Haugli Bråten
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital HF, Ulleval, Bygg 37b, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Guro Løvik Goll
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319, Oslo, Norway
| | - Monica Wigemyr
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Nils Bolstad
- Department of Medical Biochemistry, Oslo University Hospital, Radiumhospitalet, Box 4953 Nydalen, 0424, Oslo, Norway
| | - Morten Valberg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Sogn Arena 3.etg, P.O.Box 4950 Nydalen, Oslo, Norway
| | - Elina Iordanova Schistad
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Gunn Hege Marchand
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250 Torgarden, NO-7006, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, 7491, Norway
| | - Fredrik Granviken
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250 Torgarden, NO-7006, Trondheim, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, 7491, Norway
| | - Kaja Kristine Selmer
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway.,National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Anne Froholdt
- Department of Physical Medicine and Rehabilitation, Drammen Hospital, Vestre Viken Hospital Trust Drammen, P.O. Box 800, 3004, Drammen, Norway
| | - Anne Julsrud Haugen
- Department of Rheumatology, Østfold Hospital Trust, P.O. Box 300, 1714 Grålum, Moss, Norway
| | - Magnhild Hammersland Dagestad
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
| | - Nils Vetti
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of North Norway, P.O. Box 100, 9038, Tromsø, Norway
| | - Benedicte Alexandra Lie
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Espen A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319, Oslo, Norway
| | - Aksel Thuv Nilsen
- Department of Rheumatology, University Hospital of North Norway, P.O. Box 100, 9038, Tromsø, Norway
| | - Thor Einar Holmgard
- Norwegian Back Pain Association, P.O.Box 9612 Fjellhagen, 3065, Drammen, Norway
| | - Thomas Istvan Kadar
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Helse Bergen HF, Box 1, 5021, Bergen, Norway
| | - Tore Kvien
- Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316, Oslo, Norway.,Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319, Oslo, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Helse Bergen HF, Box 1, 5021, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway
| | - Lars Grøvle
- Department of Rheumatology, Østfold Hospital Trust, P.O. Box 300, 1714 Grålum, Moss, Norway
| | - Jens Ivar Brox
- Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital HF, Ulleval, Bygg 37b, P.O. Box 4956 Nydalen, 0424, Oslo, Norway.,Department of Physiotherapy, Oslo Metropolitan University, P.O. Box 4 St. Olavs plass, NO-0130, Oslo, Norway
| | - John Anker Zwart
- Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316, Oslo, Norway.,Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
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94
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Khan MNU, Morrison NMV, Marshall PW. The Role of Fear-Avoidance Beliefs on Low Back Pain-Related Disability in a Developing Socioeconomic and Conservative Culture: A Cross-Sectional Study of a Pakistani Population. J Pain Res 2020; 13:2377-2387. [PMID: 33061553 PMCID: PMC7520149 DOI: 10.2147/jpr.s258314] [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: 04/18/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background The relationship of low back pain, the world’s top disabling condition, with functional disability is often explained by the mediation effect of fear, catastrophizing, and psychological distress. These relationships have not been explored within chronic back pain patients from a low socio-economic, predominantly Muslim country. Thus, it was unclear whether previously established pathways would be consistent in Pakistani pain patients to help guide Pakistani clinicians caring for back pain patients. This cross-sectional study translated English versions of questionnaires within the fear-avoidance model into Urdu, tested the clinimetric properties of the Urdu versions for people with chronic low back pain (CLBP) in Pakistan, and performed mediation analysis to investigate pathways of the fear-avoidance model. Methods Translation of questionnaires was completed in 4 steps using the forward-backward technique, with subsequent analyses for internal consistency (Cronbach’s α), construct validity (Pearson’s r-value), and test–retest reliability (ICC r-value). Multiple mediation analysis with bootstrapping was performed to analyze pathways within the fear-avoidance model from the Urdu translated questionnaires. Results A total of 151 people from Pakistan with CLBP completed the questionnaires, with good results for internal consistency (r > 0.85), convergent validity (r > 0.59), and test–retest reliability (ICC r > 0.85). The association of pain with disability was significant (B=2.36, r2 = 0.19, p<0.001), and the indirect effect of the mediators explained 81% of pain intensity’s total effect on disability. All mediators, apart from physical activity-related fear-avoidance beliefs, were significant mediators of the effect of pain intensity on disability. Conclusion The Urdu versions of the fear-avoidance questionnaires show good clinimetric properties for use in clinical settings and research in Pakistan. These analyses support existing data for the mediation effect of catastrophizing, psychological distress, and self-efficacy on pain-related disability, and extends these findings to suggest that fear about work may be more important in a relatively lower socioeconomic sample of pain patients.
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Affiliation(s)
| | - Natalie M V Morrison
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.,Translation Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Paul W Marshall
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
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95
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Ampiah PK, Hendrick P, Moffatt F. Implementation of a biopsychosocial physiotherapy management approach for patients with non-specific chronic low back pain in Ghana: a study protocol for a mixed-methods, sequential, feasibility, pretest-posttest quasi-experimental study. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1832721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Paapa Kwesi Ampiah
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
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96
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Prevalence of Low Back Pain and Relationship to Mental Health Symptoms and Quality of Life After a Deployment-related Lower Limb Amputation. Spine (Phila Pa 1976) 2020; 45:1368-1375. [PMID: 32576777 DOI: 10.1097/brs.0000000000003525] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective, cross-sectional study. OBJECTIVE To assess the prevalence and association of low back pain (LBP) with psychosocial factors in Service members with amputations. SUMMARY OF BACKGROUND DATA LBP is a common secondary health condition after amputation with important implications related to function and quality of life. A growing body of evidence suggests that psychosocial factors influence LBP in patients without amputation. However, there is a dearth of information regarding the association of psychosocial factors and LBP after amputation. METHODS Seventy-nine individuals with lower limb amputations who were a part of the Wounded Warrior Recovery Project were included in the analysis. Data on posttraumatic stress disorder (PTSD), depression, and quality of life (QOL) were collected from the Wounded Warrior Recovery Project, while data on LBP and LBP chronicity were extracted from the Military Health System Data Repository. General linear models were utilized to analyze associations between LBP and psychosocial factors, while controlling for injury severity and time since amputation. RESULTS In individuals with amputations, 19.0% had acute LBP and 49.4% had recurrent LBP. Individuals with amputations and recurrent LBP reported higher PTSD symptom severity compared with those without LBP (B = 9.213, P < 0.05). More severe depression symptoms were observed in those with amputations and recurrent LBP compared with those without LBP (B = 5.626, P < 0.05). Among individuals with amputations, those with recurrent LBP reported lower QOL compared with those without LBP (B = -0.058, P < 0.05). There were no differences in PTSD, depression or QOL in those with amputations with and without acute LBP. CONCLUSIONS Presence of recurrent LBP after amputation appears to be associated with more severe PTSD and depression symptoms as well as lower QOL. Further research is needed to assess the efficacy of addressing psychosocial factors for improving pain and function in service members with amputations and LBP. LEVEL OF EVIDENCE 3.
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97
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Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials. Pain Rep 2020; 5:e847. [PMID: 33490842 PMCID: PMC7808677 DOI: 10.1097/pr9.0000000000000847] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Randomized trials have examined the efficacy of psychologically informed physical therapy methods including graded activity or graded exposure, cognitive-behavioral-based physical therapy, acceptance and commitment-based physical therapy, and internet-based psychological programs compared to traditional physical therapy approaches for musculoskeletal pain. Summary findings suggest that psychologically informed physical therapy is a promising care model; however, more convincing evidence is needed to support widespread adoption, especially in light of clinician training demands. Psychologically informed physical therapy (PIPT) blends psychological strategies within a physical therapist's treatment approach for the prevention and management of chronic musculoskeletal pain. Several randomized trials have been conducted examining the efficacy of PIPT compared to standard physical therapy on important patient-reported outcomes of disability, physical function, and pain. In this review, we examine recent trials published since 2012 to describe current PIPT methods, discuss implications from findings, and offer future directions. Twenty-two studies, representing 18 trials, were identified. The studied PIPT interventions included (1) graded activity or graded exposure (n = 6), (2) cognitive-behavioral-based physical therapy (n = 9), (3) acceptance and commitment-based physical therapy (n = 1), and (4) internet-based psychological programs with physical therapy (n = 2). Consistent with prior reviews, graded activity is not superior to other forms of physical activity or exercise. In a few recent studies, cognitive-behavioral-based physical therapy had short-term efficacy when compared to a program of standardized exercise. There is a need to further examine approaches integrating alternative strategies including acceptance-based therapies (ie, acceptance and commitment therapy or mindfulness) or internet-based cognitive-behavioral programs within physical therapy. Although PIPT remains a promising care model, more convincing evidence is needed to support widespread adoption, especially in light of training demands and implementation challenges.
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98
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Toomey D, Reid D, White S. How manual therapy provided a gateway to a biopsychosocial management approach in an adult with chronic post-surgical low back pain: a case report. J Man Manip Ther 2020; 29:107-132. [PMID: 32930642 DOI: 10.1080/10669817.2020.1813472] [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] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The management of patients with chronic post-surgical low back pain can be very challenging to surgeons, physiotherapists, and patients alike. Subsequent surgery is often associated with post-operative complications and even lower levels of success than the initial spinal surgery. Physiotherapy is often recommended as the first-line management, however, debate exists amongst physiotherapists regarding the optimal treatment strategy. A key focus of this debate has been the use of manual therapy in chronic pain populations, leading clinicians to reevaluate its use. CASE DESCRIPTION A 44-year-old female presented to physiotherapy with a 13-year history of persistent pain, having had a spinal fusion 12 years prior, following a skiing accident. Her primary complaints were pain and decreased self-efficacy. The patient was treated with a 12-week multimodal approach consisting of manual therapy, exercise rehabilitation, and pain neuroscience education. OUTCOMES The patient had a significant reduction in the Numerical Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI) and the Fear Avoidance Belief Questionnaire Physical Activity Subscale (FABQ-PA) scores following the intervention. She returned to running and cycling, reporting that pain was something she would 'work with instead of against'. DISCUSSION This case study suggests that manual therapy can enhance an individualized biopsychosocial approach in the physiotherapy management of a patient with chronic post-surgical low back pain. Further research is needed to evaluate optimal intervention dosages and effective strategies in the management of patients with chronic low back pain following spinal surgery.
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Affiliation(s)
- David Toomey
- Auckland University of Technology, Auckland, New Zealand.,Waiheke Physiotherapy and Pilates, Auckland, New Zealand
| | - Duncan Reid
- Auckland University of Technology, Auckland, New Zealand
| | - Steven White
- Auckland University of Technology, Auckland, New Zealand
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99
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Avila L, Neves ML, Abreu AR, Fiuza CR, Fukusawa L, Meziat-Filho N, Soares Santos AR. Cognitive functional therapy (CFT) compared with core training exercise (CTE) in patients with failed back surgery syndrome (FBSS): A study protocol for a randomized controlled trial. J Bodyw Mov Ther 2020; 26:428-434. [PMID: 33992278 DOI: 10.1016/j.jbmt.2020.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/09/2020] [Accepted: 08/29/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aims to investigate the efficacy of cognitive functional therapy (CFT) compared to core training exercise (CTE) on pain and specific disability of patients with failed back surgery syndrome (FBSS). DESIGN This will be a randomized controlled clinical trial of two groups with blinded evaluators. SETTING The study will be conducted at the Federal University of Santa Catarina (UFSC) and a private clinic in Florianópolis, SC, Brazil. PARTICIPANTS A total of 80 participants, of both sexes, with FBSS. INTERVENTION Subjects will be randomized into two groups: one group receiving CFT or CTE. Individuals will be assisted once a week, for a maximum period of 12 weeks, with four being the minimum number of visits and 12 being the maximum number of visits. MEASUREMENTS The primary outcomes will be pain and specific disability. CONCLUSIONS This is the first study investigating whether CFT is efficacious for patients with FBSS and chronic low back pain. The study's sample size was calculated to detect the effect of clinically relevant treatment with a low risk of bias. This clinical trial was designed to be able to reproduce an approach as a physiotherapist trained in CFT would do. That is, in a pragmatic way, increasing the significance of this study. CTE comprises a strategy widely used by physiotherapists to treat low back pain. Given that the scientific evidence of its efficacy for pain management is limited, the findings of this study will assist physiotherapists in their clinical decision-making.
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Affiliation(s)
- Leonardo Avila
- Postgraduate Program of Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
| | - Marcos Lisboa Neves
- Postgraduate Program of Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
| | - André Rogério Abreu
- Postgraduate Program of Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
| | - Cibelle Ramos Fiuza
- Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Multicenter Postgraduate Program in Physiological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
| | - Leandro Fukusawa
- Masters and Doctoral Programs in Medical Sciences, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
| | - Ney Meziat-Filho
- Postgraduate Program of Rehabilitation Science, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil.
| | - Adair Roberto Soares Santos
- Postgraduate Program of Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
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100
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What do UK osteopaths view as the safest lifting posture, and how are these views influenced by their back pain beliefs? INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2020.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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