Community survey of factors associated with consultation for low back pain

Chronic pain and the use of conventional and alternative therapy

BACKGROUND

Chronic pain is a common problem affecting about half of the general population. This has implications for the utilization of both conventional and alternative health services.

OBJECTIVES

The aim of this study was to determine the use of conventional and alternative practitioners and medicines amongst individuals with chronic pain in the community.

METHODS

A total of 2422 individuals from a previous population-based survey in the Grampian region of the UK, who agreed to participate in further research, were sent a postal questionnaire. The questionnaire enquired about the presence, type and severity of chronic pain, socio-demographic details, consultations with conventional and alternative practitioners, and the consumption of conventional and alternative medicines. The main outcome measures were the number and frequency of self-reported consultations with GPs, hospital specialists, physical therapists and alternative therapists, and the consumption of prescription, non-prescription and alternative medicines amongst those with chronic pain.

RESULTS

Of the 840 individuals reporting chronic pain, 67.2% had seen their GP, 34.0% a hospital specialist, 25.9% a physical therapist and 18.2% an alternative therapist in the preceding year. Prescription medicines had been taken by 58.4%, non-prescription medicines by 57.4% and alternative medicines by 15.7% of individuals with chronic pain. The majority (67.0%) of individuals with chronic pain who sought alternative health care did so in conjunction with conventional health care. Differences in consultations with practitioners and consumption of medicines were found by age, sex, socio-economic status, site of pain and severity of pain.

CONCLUSIONS

Individuals with chronic pain consult their GP about their pain more than other practitioners and use conventional medicines more frequently than alternative medicines. Alternative health care is used most commonly in addition to conventional health care, although a small number of individuals with chronic pain use alternative care exclusively. The use of alternative health care amongst those with chronic pain is higher than previously estimated and suggests that the use of these services may be increasing amongst those with chronic pain.

The use and reported effects of mobilization with movement techniques in low back pain management; a cross-sectional descriptive survey of physiotherapists in Britain

Manual therapy is the most commonly used approach in the management of low back pain (LBP) and encompasses a wide range of techniques. The aims of this study were to investigate the current use of mobilizations with movement (MWM) for LBP management in Britain and to inform future clinical research exploring their effects.A postal survey of a random sample of 3295 practising physiotherapists in Britain was conducted. A response rate of 72.1% (n=2357) was obtained. Of these, 48.2% (n=1136) reported treating LBP, of whom 41.1% (n=467) reported using MWMs in LBP management. Therefore, the sample applicable for analysis consisted of these 467 therapists currently treating LBP and using MWMs. Most respondents (51.4%) worked in a national health service setting. Over half of the respondents used MWMs on at least a weekly basis, with 61.9% using MWMs primarily for mechanical LBP. The most commonly reported changes seen immediately after the application of MWMs were increases in range of movement (ROM) (54.4%) and pain relief (27.5%). This was also reflected in the outcomes chosen to evaluate improvement. On average, two spinal levels were mobilized using 2-3 sets of 4-5 repetitions. The lower lumbar levels were treated more often. Most therapists indicated using a combination of other treatment approaches together with MWMs when treating LBP patients. In conclusion, this study is the first to describe the current practice of MWMs by physiotherapists in Britain, and the results will be used to inform the design of a clinical trial exploring the effects of MWMs for LBP.

Why do patients with chronic musculoskeletal disorders consult their primary care physicians?

Symptoms are a daily occurrence in the lives of most people, and many do not consult their doctors for their clinical complaints. Information on the frequency of musculoskeletal disorders and on healthcare utilization patterns can be obtained from population surveys or from records of visits to primary care physicians. A decision to consult a primary care physician for musculoskeletal disorders is not based simply on the presence or absence of physical symptoms, but also involves a complex mixture of social and psychological factors.

A population study of factors associated with general practitioner consultation for non-inflammatory musculoskeletal pain

OBJECTIVE

To investigate factors associated with visiting a general practitioner (GP) for non-inflammatory musculoskeletal pain, and to examine whether these factors were affected by duration (chronic v non-chronic) or location (widespread v regional) of pain.

METHODS

From a cross sectional postal survey of 20 000 (response rate 59%) randomly selected adults in two counties of Norway, 6408 subjects who had experienced musculoskeletal pain during the past month were included. Patients who reported inflammatory rheumatic diagnoses made by a doctor were excluded.

RESULTS

2909 (45%) had consulted a GP for their musculoskeletal pain during the past 12 months. The odds of consulting were significantly increased by being a woman, by having a higher age and lower education, and by being a pensioner or on sick leave. Patients with widespread pain were more likely to consult than those with regional pain, as were patients with chronic compared with non-chronic pain. Greater than median pain intensity was the factor most prominently associated with consultation for men (odds ratio (OR)=2.4; 95% confidence interval (95% CI) 2.0 to 2.9) and for women (OR=2.6; 95% CI 2.3 to 2.9). Overall, consultation was significantly associated with mental distress for women but not for men. Subgroup analyses showed that consultation for chronic pain was significantly associated with greater than median mental distress for both women (OR=1.3; 95% CI 1.1 to 1.6) and men (OR=1.2; 95% CI 1. 0 to 1.4), whereas consultation for non-chronic pain was not.

CONCLUSION

The results show that about half of the patients with musculoskeletal pain consult a general practitioner (GP) each year, that demographic factors are associated with consulting, and that the role of mental distress for consulting a GP varies with duration of pain.

Biopsychosocial screening questionnaire for patients with low back pain: preliminary report of utility in physiotherapy practice in Northern Ireland

OBJECTIVE

The aim of this study was to investigate the potential utility of a new biopsychosocial screening questionnaire (Acute Low Back Pain Screening Questionnaire) by exploring the relation between it and several physical risk factors and posttreatment outcomes so as to establish a cutoff point for the local population. The relation between the screening questionnaire and valid and reliable outcome measures of pain and functional disability was also explored.

DESIGN

Cross-sectional and longitudinal studies were conducted on patients referred for physiotherapy for low back pain to a large Healthcare Trust in Northern Ireland. Before initial assessment, patients completed the screening questionnaire and outcome measures, were questioned about known physical risk factors, and then received physiotherapy. At final discharge, the outcome variables--the "number of treatments" and patient's current work status ("return to work [yes/no]")--were recorded, and patients recompleted the outcome measures.

PATIENTS

One hundred eighteen patients gave written informed consent to participate in this study.

RESULTS

Significant associations were detected between questionnaire scores and pretreatment "leisure time exercise," "analgesic medication use," and "subjective anesthesia"; posttreatment "return to work"; and "number of physiotherapy treatments" as well as pain and functional disability measures. A cutoff "at-risk" score of 112 was calculated, which correctly classified 74% of patients who received more than six treatments and 80% of patients who failed to return to work at the end of treatment.

CONCLUSIONS

The findings of this study provide preliminary evidence of the utility of this biopsychosocial screening questionnaire for future use in clinical intervention studies in the Northern Ireland National Health Service. Further comparative investigations in other health care settings are warranted.

A prospective follow-up study of low back pain in the community

STUDY DESIGN

Opportunistic prospective follow-up study.

OBJECTIVE

To describe the natural history of low back pain in the community and to model the factors predictive of recovered versus persistent low back pain.

SUMMARY OF BACKGROUND DATA

A two-phase questionnaire was mailed to adults in the Bradford Metropolitan Health District in 1994. Valid respondents were surveyed again in 1997. Analysis is based on the combined results of these two surveys.

METHODS

Unifactorial and multifactorial statistics were analyzed based on 1455 adults, with and without low back pain.

RESULTS

One third of respondents reported no lifetime low back pain. Average lifetime prevalence was 59% and average annual prevalence 41%. Of those who reported lifetime low back pain, 42% reported persistent annual low back pain, 18% reported a first episode in 1997, resulting in a 4% population incidence rate, and 40% reported intermittent low back pain. The likelihood of having had low back pain increased significantly with age. Those who reported a new case of low back pain in 1997 were significantly more likely to be 25-34 years of age, and these persons were most likely to report acute low back pain with very little disability. Those with persistent low back pain were significantly more likely to report chronic low back pain with some disability. Logistic regression modeling was unable to predict recovered versus persistent low back pain, given the person, pain, and treatment factors available.

CONCLUSIONS

Results showed that low back pain is a mutable problem with acute episodes blending into longer periods resulting in more disability as time progresses. A wide range of demographic, pain, consultation, and treatment factors were not predictive of low back pain recovery.

Welfare to work: the role of general practice

This paper considers the potential effects of the government's Welfare to Work policy on general practitioner (GP) working patterns, and aims to explore the relationship between unemployment, ill health, and GP sickness certification. Social security and employment policy initiatives are discussed in relation to the literature on the relationship between unemployment and ill health, sociological and psychological perspectives on work and unemployment, medicalisation of unemployment, adjudication of fitness for work, re-employment and health, and treatment of barriers to employment. The authors postulate that Welfare to Work policy may depend for its success on the crucial role of general practice in sickness certification.

The role of physical and psychological factors in occupational low back pain: a prospective cohort study

OBJECTIVE

To examine risk factors for onset of low back pain (LBP) in healthcare workers.

METHODS

Nursing students, during their 3 year training period, and 1 year after training were studied in a prospective cohort study, with repeated self reported measurements of determinants of LBP at 6 monthly intervals for 3 years during training, and after a 12 month interval there was an additional final follow up.

RESULTS

During training, increased risk of new episodes of LBP was associated with having had LBP at baseline, with part time work, and with a high score on the general health questionnaire (GHQ). A high GHQ score preceded the onset of LBP, in such a way that a high score at the immediately previous follow up increased risk of LBP at the next follow up. 12 Months after training, a history of recurring LBP during training increased the risk of a new episode as did having obtained work as a nurse. A high GHQ score at this follow up was also associated with a concurrently increased risk. Pre-existing GHQ score, either at the end of training or at baseline, had no effect on risk of LBP 12 months after training.

CONCLUSIONS

Other than a history of LBP, pre-existing psychological distress was the only factor found to have a pre-existing influence on new episodes of LBP. Increased levels of psychological distress (as measured by the GHQ) preceded the occurrence of new episodes of pain by only short intervening periods, implying a role for acute distress in the onset of the disorder. This finding suggests that management of the onset of occupational LBP may be improved by management of psychological distress.

Prevalence of back, neck and shoulder problems in the inner city: implications for the provision of physiotherapy services in primary healthcare

BACKGROUND AND PURPOSE

More general practitioners are offering physiotherapy services within primary healthcare; however, this provision may result in increased demand. Resource allocation, based on previous patterns of consultation for musculoskeletal conditions, may be inadequate since the need for treatment in the community may not have been met in the past. Therefore the aim of this study was to determine the prevalence of back, neck and shoulder problems that had restricted normal activity for more than one week during the last year and which health professionals (if any) patients had consulted about their symptoms.

METHOD

A postal survey of 2400 adult patients selected at random from four general practices in Newcastle upon Tyne (600 from each practice).

RESULTS

A total of 1546 questionnaires were returned, a 64% response rate. Overall, 40% of respondants reported having at least one back, neck and/or shoulder problem. Back problems were most common (30%), followed by those with neck (21%) and shoulder (20%) problems. Approximately one-third of those with problems consulted no one, a further third consulted a general practitioner and only one in six consulted a physiotherapist.

CONCLUSIONS

There is a high prevalence of substantial back, neck and shoulder problems in the community and thus a wider provision of physiotherapy services within primary healthcare may be required to manage the considerable levels of potentially unmet need.