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Petrozzi MJ, Spencer G, Mackey MG. A process evaluation of the Mind Your Back trial examining psychologically informed physical treatments for chronic low back pain. Chiropr Man Therap 2021; 29:32. [PMID: 34404446 PMCID: PMC8369773 DOI: 10.1186/s12998-021-00389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background In chronic conditions, such as back pain, the use of interventions that address physical, social and psychological aspects within a biopsychosocial framework are encouraged, however, applying this holistic multimodal approach in physical therapy practice (i.e., chiropractic and physiotherapy) is challenging. To explore the problem of delivering a biopsychosocially informed package of care in physical therapy practice a recent randomised control trial (RCT) called ‘Mind Your Back’ was conducted to evaluate the effectiveness of a combined physical and internet-delivered psychological intervention (psychologically informed physical treatments) compared to standard treatment for improving disability and self-efficacy in people with chronic LBP. The results of the trial indicated no difference between the two intervention groups. Although high-quality RCTs are considered gold standard for effectiveness of interventions, qualitative research methods embedded within a process evaluation framework are also used to reveal other issues and important information that help to explain clinical trial results, and to further the field of digital health interventions research. Therefore, within a process evaluation framework, the aim is to explore participants experiences of the interventions received throughout the Mind Your Back trial which led to a null result. Methods In-line with recommendations for a process evaluation this study used in-depth interviews and qualitative thematic analysis with participants of both arms of the trial 5–6 months after study completion. Semi-structured telephone interviews were conducted with twenty-five participants to explore their experiences of taking part in the Mind Your Back trial. Interviews were conducted in November 2017, transcribed verbatim and data analysed thematically. Results Two main themes were identified: (1) Personalised support and therapeutic alliance are important, and (2) MoodGYM lacked relevant, personalised and tailored support. Conclusion It is important to deliver tailored digital health supports that is personalised and fosters a therapeutic alliance. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00389-y.
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Affiliation(s)
- M John Petrozzi
- Faculty of Medicine and Health, The University of Sydney, Level 7, Susan Wakil Health Building D18, Sydney, NSW, 2006, Australia.
| | - Grace Spencer
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Martin G Mackey
- Faculty of Medicine and Health, The University of Sydney, Level 7, Susan Wakil Health Building D18, Sydney, NSW, 2006, Australia
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Cashin AG, Lee H, Traeger AC, Moseley GL, Hübscher M, Kamper SJ, Skinner IW, McAuley JH. Producing Clinically Meaningful Reductions in Disability: A Causal Mediation Analysis of a Patient Education Intervention. THE JOURNAL OF PAIN 2021; 23:236-247. [PMID: 34411745 DOI: 10.1016/j.jpain.2021.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
Patient education is recommended as first-line care for low back pain (LBP), although its efficacy for providing clinically meaningful reductions in disability has been questioned. One way to improve treatment effects is to identify and improve targeting of treatment mechanisms. We conducted a pre-planned causal mediation analysis of a randomized, placebo-controlled trial investigating the effectiveness of patient education for patients with acute LBP. 202 patients who had fewer than six-weeks' duration of LBP and were at high-risk of developing chronic LBP completed two, one-hour treatment sessions of either intensive patient education, or placebo patient education. 189 participants provided data for the outcome self-reported disability at three-months and the mediators, pain self-efficacy, pain catastrophizing, and back beliefs at one-week post treatment. This causal mediation analysis found that pain catastrophizing (mediated effect, -0.64; 95% Confidence Interval [CI], -1.31 to -0.15) and back beliefs (mediated effect, -0.51; 95% CI, -1.15 to -0.02) partly explained the effect of patient education on disability but pain self-efficacy did not (mediated effect, -0.40; 95% CI -1.13 to 0.28). Considering the mediator-outcome relationship, patient education would need to induce an 8 point difference on the pain self-efficacy questionnaire (0-60); an 11 point difference on the back beliefs questionnaire (9-45); and a 21 point difference on the pain catastrophizing scale (0-52) to achieve a minimally clinically important difference of 2 points on the Roland Morris Disability Questionnaire (0-24). PERSPECTIVE: Understanding the mechanisms of patient education can inform how this treatment can be adapted to provide clinically meaningful reductions in disability. Our findings suggest that adapting patient education to better target back beliefs and pain self-efficacy could result in clinically meaningful reductions in disability whereas the role of pain catastrophizing in acute LBP is less clear.
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Affiliation(s)
- Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Markus Hübscher
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Steven J Kamper
- School of Health Sciences, The University of Sydney, Sydney, Australia; Nepean Blue Mountains Local Health District, NSW, Australia; Centre for Pain, Health and Lifestyle, Australia
| | - Ian W Skinner
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Port Macquarie, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Health Sciences, University of New South Wales, Sydney, Australia.
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103
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Bakaa N, Chen LH, Carlesso L, Richardson J, Shanthanna H, Macedo L. Understanding barriers and facilitators of exercise adherence after total-knee arthroplasty. Disabil Rehabil 2021; 44:6348-6355. [PMID: 34397309 DOI: 10.1080/09638288.2021.1965232] [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: 10/20/2022]
Abstract
PURPOSE The purpose of this qualitative study is to understand the perceived patient barriers and facilitators of post-surgical exercise adherence in patients undergoing TKA. MATERIAL AND METHODS We used an interpretive description approach. Data was gathered using semi-structured qualitative interviews. Participants were interviewed at 8 weeks post-operatively to capture physical, psychological, social and contextual changes and information. Topics that were explored included participants' experience with physical activity and exercise, motivation to perform physical activity, beliefs that exercise will reduce pain, factors that limit their ability to engage in exercise, and the importance of self-regulation in exercise adherence. RESULTS This study identified 4 themes within the WHO adherence framework: patient-related factors, condition-related factors, health care system, and social support. In particular, self-regulation, knowledge of exercise, post-operative complications, comorbidities, social support, and lack of guidance from health care providers were identified as personal and environmental characteristics that influence exercise adherence. CONCLUSION Exercise adherence is a multidimensional, interconnected construct and future research should focus on understanding the factors, particularly health care system, that impact adherence.IMPLICATIONS FOR REHABILITATIONRehabilitation therapists should aim to foster competence and confidence in post-operative rehabilitation by implementing strategies such as positive-reinforcement, goal setting, and increased education regarding the benefits of exercise.Clinical strategies to improve exercise adherence should be implemented both pre-and-post-operatively.Health care providers should clearly discuss post-operative outcomes and expectations (e.g., complications, etc.) with patients prior to surgery.
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Affiliation(s)
- Nora Bakaa
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Lu Hsi Chen
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Lisa Carlesso
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Harsha Shanthanna
- Anesthesia, St. Joseph's Hospital, McMaster University, Hamilton, Canada
| | - Luciana Macedo
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
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104
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Brunner E, Meichtry A, Vancampfort D, Imoberdorf R, Gisi D, Dankaerts W, Graf A, Wipf Rebsamen S, Suter D, Wildi LM, Buechi S, Sieber C. Influence of weekday of admission and level of distress on length of hospital stay in patients with low back pain: a retrospective cohort study. BMC Musculoskelet Disord 2021; 22:656. [PMID: 34353298 PMCID: PMC8340547 DOI: 10.1186/s12891-021-04529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is often a complex problem requiring interdisciplinary management to address patients' multidimensional needs. Providing inpatient care for patients with LBP in primary care hospitals is a challenge. In this setting, interdisciplinary LBP management is often unavailable during weekends. Delays in therapeutic procedures may result in a prolonged length of hospital stay (LoS). The impact of delays on LoS might be strongest in patients reporting high levels of psychological distress. Therefore, this study investigates the influence of weekday of admission and distress on LoS of inpatients with LBP. METHODS This retrospective cohort study was conducted between 1 February 2019 and 31 January 2020. In part 1, a negative binomial model was fitted to LoS with weekday of admission as a predictor. In part 2, the same model included weekday of admission, distress level, and their interaction as covariates. Planned contrast was used in part 1 to estimate the difference in log-expected LoS between group 1 (admissions Friday/Saturday) and the reference group (admissions Sunday-Thursday). In part 2, the same contrast was used to estimate the corresponding difference in (per-unit) distress trends. RESULTS We identified 173 patients with LBP. The mean LoS was 7.8 days (SD = 5.59). Patients admitted on Friday (mean LoS = 10.3) and Saturday (LoS = 10.6) had longer stays, but not those admitted on Sunday (LoS = 7.1). Analysis of the weekday effect and planned contrast showed that admission on Friday or Saturday was associated with a significant increase in LoS (log ratio = 0.42, 95% CI = 0.21 to 0.63). A total of 101 patients (58%) returned questionnaires, and complete data on distress were available from 86 patients (49%). According to the negative binomial model for LoS and the planned contrast, the distress effect on LoS was significantly influenced (difference in slopes = 0.816, 95% CI = 0.03 to 1.60) by dichotomic weekdays of admission (Friday/Saturday vs. Sunday-Thursday). CONCLUSIONS Delays in interdisciplinary LBP management over the weekend may prolong LoS. This may particularly affect patients reporting high levels of distress. Our study provides a platform to further explore whether interdisciplinary LBP management addressing patients' multidimensional needs reduces LoS in primary care hospitals.
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Affiliation(s)
- Emanuel Brunner
- Department of Physiotherapy and Rehabilitation, Winterthur Cantonal Hospital, Brauerstrasse 15, CH-801 Winterthur, Switzerland
- Department of Health, OST – Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - André Meichtry
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Reinhard Imoberdorf
- Department of Internal Medicine, Winterthur Cantonal Hospital, Winterthur, Switzerland
| | - David Gisi
- Department of Physiotherapy and Rehabilitation, Winterthur Cantonal Hospital, Brauerstrasse 15, CH-801 Winterthur, Switzerland
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Anita Graf
- Department of Physiotherapy and Rehabilitation, Winterthur Cantonal Hospital, Brauerstrasse 15, CH-801 Winterthur, Switzerland
| | - Stefanie Wipf Rebsamen
- Department of Physiotherapy and Rehabilitation, Winterthur Cantonal Hospital, Brauerstrasse 15, CH-801 Winterthur, Switzerland
| | - Daniela Suter
- Department of Medicine, Nursing, Winterthur Cantonal Hospital, Winterthur, Switzerland
| | - Lukas Martin Wildi
- Department of Medicine, Institute of Rheumatology, Winterthur Cantonal Hospital, Winterthur, Switzerland
| | - Stefan Buechi
- Clinic for Psychotherapy and Psychosomatics “Hohenegg”, Meilen, Switzerland
| | - Cornel Sieber
- Department of Internal Medicine, Winterthur Cantonal Hospital, Winterthur, Switzerland
- Institute for Biomedicine of Ageing, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
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Unsgaard-Tøndel M, Søderstrøm S. Therapeutic Alliance: Patients' Expectations Before and Experiences After Physical Therapy for Low Back Pain-A Qualitative Study With 6-Month Follow-Up. Phys Ther 2021; 101:6330887. [PMID: 34339506 PMCID: PMC8632789 DOI: 10.1093/ptj/pzab187] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/19/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to explore patients' expectations before and experiences after physical therapy for low back pain. METHODS Qualitative in-depth, semi-structured interviews with patients attending physical therapy were performed before, immediately after, and 6 months after treatment. Data were analyzed from a hermeneutical perspective with decontextualization, recontextualization, and identification of themes. RESULTS Patients' pretreatment expectations to physical therapy focused around exercises and a body-oriented diagnosis. After treatment, reassurance, active listening with explanations, and personally adapted strategies for self-managing pain and regaining control over everyday activity were expressed as decisive for a meaningful therapeutic alliance. CONCLUSION Expectations before treatment focused on exercises and diagnosis. Empathetic and personally adapted education aimed at empowerment was experienced as a meaningful aspect of the therapeutic alliance after treatment. The therapeutic alliance provided a basis to integrate knowledge on the complexity of pain. IMPACT Our findings indicate that patients emphasize physical therapists' interactional and pedagogical skills as meaningful aspects of the therapeutic alliance, which has implications for clinical practice and training physical therapist students.
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Affiliation(s)
- Monica Unsgaard-Tøndel
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway,Department of Physical Therapy, Trondheim Municipality, Trondheim, Norway,Address all correspondence to Dr Unsgaard-Tøndel at:
| | - Sylvia Søderstrøm
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
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106
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George SZ, Lentz TA, Goertz CM. Back and neck pain: in support of routine delivery of non-pharmacologic treatments as a way to improve individual and population health. Transl Res 2021; 234:129-140. [PMID: 33901699 PMCID: PMC8340679 DOI: 10.1016/j.trsl.2021.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/29/2022]
Abstract
Chronic back and neck pain are highly prevalent conditions that are among the largest drivers of physical disability and cost in the world. Recent clinical practice guidelines recommend use of non-pharmacologic treatments to decrease pain and improve physical function for individuals with back and neck pain. However, delivery of these treatments remains a challenge because common care delivery models for back and neck pain incentivize treatments that are not in the best interests of patients, the overall health system, or society. This narrative review focuses on the need to increase use of non-pharmacologic treatment as part of routine care for back and neck pain. First, we present the evidence base and summarize recommendations from clinical practice guidelines regarding non-pharmacologic treatments. Second, we characterize current use patterns for non-pharmacologic treatments and identify potential barriers to their delivery. Addressing these barriers will require coordinated efforts from multiple stakeholders to prioritize evidence-based non-pharmacologic treatment approaches over low value care for back and neck pain. These stakeholders include patients, health care providers, health care organizations, administrators, payers, policymakers and researchers.
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Affiliation(s)
- Steven Z George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Trevor A Lentz
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Christine M Goertz
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
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107
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Jain S, Jha S, Shetty G, Ram CS. Patient Expectations From Consultation and Treatment of Spine Pain in a Private Spine Rehabilitation Clinic in Urban India. J Patient Exp 2021; 8:23743735211034076. [PMID: 34377771 PMCID: PMC8326608 DOI: 10.1177/23743735211034076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite high prevalence of spine pain among the Indian population, patient expectations regarding consultation and its treatment are unknown. We aimed to determine consultation and treatment expectations among patients visiting a spine rehabilitation clinic in urban India. We included 194 consecutive patients who completed a consultation expectation (CE) and treatment outcome expectation (OE) questionnaires and the Patient-Centered Outcome Questionnaire (PCOQ). To learn about the most suitable treatment for their problem (98%), and to know what kind of activities they could do and should avoid (96%) were the most important CEs, and to achieve complete relief of symptoms (96%), and prevent recurrence of pain (95%) were the most important OEs. For successful treatment, patients expected PCOQ pain levels of 2.0 (96.5% reduction) and interference levels of 1.5 (96% reduction). Patients expected to know the most suitable treatment, activities they could do and avoid after consultation, and to achieve complete relief of symptoms and prevent recurrence after treatment. Incorporating and addressing these expectations may help improve outcomes and satisfaction with the consultation and treatment of spine pain.
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Affiliation(s)
| | | | | | - C S Ram
- I.T.S College of Physiotherapy, Ghaziabad, Uttar Pradesh, India
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108
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Ho EK, Ferreira ML, Bauman A, Hodges PW, Maher CG, Simic M, Morton RL, Lonsdale C, Li Q, Baysari MT, Amorim AB, Ceprnja D, Clavisi O, Halliday M, Jennings M, Kongsted A, Maka K, Reid K, Reynolds T, Ferreira PH. Effectiveness of a coordinated support system linking public hospitals to a health coaching service compared with usual care at discharge for patients with chronic low back pain: protocol for a randomised controlled trial. BMC Musculoskelet Disord 2021; 22:611. [PMID: 34243746 PMCID: PMC8272287 DOI: 10.1186/s12891-021-04479-z] [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: 05/20/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Although many people with chronic low back pain (LBP) improve following conservative treatment, one in five will experience worsening symptoms after discharge from treatment and seek health care again. The current LBP clinical care pathway in many health services lacks a well-integrated, systematic approach to support patients to remain physically active and self-manage their symptoms following discharge from treatment. Health coaching can support people to improve physical activity levels and may potentially reduce health care utilisation for LBP. The primary aim of this study is to evaluate the effect of introducing a coordinated support system (linking hospital outpatient physiotherapy services to a public health coaching service) at discharge from LBP treatment, on the future use of hospital, medical, and health services for LBP, compared with usual care provided at discharge. Methods Three hundred and seventy-four adults with chronic non-specific LBP will be recruited from the outpatient physiotherapy departments of public hospitals in New South Wales, Australia. Participants will be individually randomised to a support system (n = 187) or usual care group (n = 187). All participants will receive usual care provided at discharge from treatment. Participants allocated to the support system will also receive up to 10 telephone-based health coaching sessions, delivered by the Get Healthy Service®, over a 6-month period. Health coaches will monitor and support participants to improve physical activity levels and achieve personal health-related goals. The primary outcome is the total number of encounters with hospital, medical, and health services for LBP, at 12 months from baseline. A within-trial economic evaluation will quantify the incremental costs and benefits of the support system from a health system perspective, to support reimbursement decision making. Discussion This study will establish the effect of a coordinated support system, introduced at discharge from treatment, on the future use of hospital, medical, and health services for LBP and various health outcomes. Conclusion Innovative community-driven solutions to support people with chronic LBP after discharge from treatment are urgently needed. Study findings will help inform health care policy and clinical practice in Australia. Trial Registration Prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12620000889954) on 10/09/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04479-z.
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Affiliation(s)
- Emma K Ho
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia.
| | - Manuela L Ferreira
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Adrian Bauman
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Paul W Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Milena Simic
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Chris Lonsdale
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Anita B Amorim
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Dragana Ceprnja
- Physiotherapy Department, Westmead Hospital, Sydney, NSW, Australia
| | - Ornella Clavisi
- Musculoskeletal Australia, Muscle Bone & Joint Health Ltd, Melbourne, VIC, Australia
| | - Mark Halliday
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Matthew Jennings
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Alice Kongsted
- Department of Sports Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Katherine Maka
- Physiotherapy Department, Westmead Hospital, Sydney, NSW, Australia
| | - Kate Reid
- The Centre for Population Health, NSW Ministry of Health, Sydney, NSW, Australia
| | - Tahlia Reynolds
- The Centre for Population Health, NSW Ministry of Health, Sydney, NSW, Australia
| | - Paulo H Ferreira
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
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Macedo LG, Richardson J, Battie MC, Hancock M, Kwan M, Hladysh G, Zhuo L. Back to living well: community-based management of low back pain: a feasibility study. Pilot Feasibility Stud 2021; 7:134. [PMID: 34167584 PMCID: PMC8223312 DOI: 10.1186/s40814-021-00863-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is a long-term health condition with an unpredictable pattern of symptomatic episodes, remission, and recurrence. Recently published systematic reviews suggest that exercise is the most effective intervention for preventing recurrences of LBP in persons that have recovered. Similar programs may also be effective in preventing flare-ups in persistent LBP. The aim of this study was to test the feasibility of the Back to Living Well program (Physical activity + Education + Self-management) developed to prevent recurrence or flare-ups of LBP. The study evaluated feasibility in terms of recruitment rate, adherence, satisfaction with the exercise and education sessions, and the data collection procedures. We also aimed to evaluate barriers and facilitators to the engagement in the program. METHODS Seventeen participants with non-specific LBP recently discharged from care from physiotherapy, chiropractors or physician care (< 3 months) were referred to the study by health care providers or community advertisements between December 2018 and February 2019. Participants underwent a 12-week (1 session/week) individualized, group-based exercise in the community and 4 sessions (30 min each) of education. All participants completed an action plan weekly for 12 weeks and wore an activity monitor for 6 months. All participants responded to weekly pain measures and completed study questionnaires at baseline, 3- and 6-months. Feasibility outcomes included recruitment, attrition rates and satisfaction. At the end of the intervention, participants completed an end-of-program survey. RESULTS Twenty-nine participants were screened for eligibility; 20 were deemed eligible, while 17 were included over a 2-month period meeting our feasibility targets. In total, 16 completed follow-up study questionnaires at 3 months, and 15 completed the 6-month follow-up. Fourteen participants responded to weekly messages, while 3 participants reported not having a mobile device or Internet access. In total, 15 participants responded to our end-of-program survey. Average age was 54.9 (11.7); 9 were female (53%), and the mean duration of LBP was 62.9 (69.7) months. All satisfaction responses in relation to the exercise program, education program and data collection procedures reached our threshold of 70% out of 100%. Reported barriers to engagement in the program included fear of injury, lack of motivation and travel. Facilitators included proximity to home, low cost, flexible schedule and friendly location. CONCLUSION The results show the program is feasible in terms of recruitment, low attrition, and patient satisfaction. Participants highlighted the excellent, relevant education program and the positive, personalized exercise. Future studies should evaluate the effectiveness of this intervention within a fully powered randomized controlled trial. TRIAL REGISTRATION NCT03328689.
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Affiliation(s)
- Luciana G Macedo
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Julie Richardson
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michele C Battie
- School of Physical Therapy and Western's Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Mark Hancock
- Macquarie University, Sydney, New South Wales, Australia
| | - Matthew Kwan
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Linda Zhuo
- Western University, London, Ontario, Canada
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Gonzalez AI, Kortlever JTP, Brown LE, Ring D, Queralt M. Can Crafted Communication Strategies Allow Musculoskeletal Specialists to Address Health Within the Biopsychosocial Paradigm? Clin Orthop Relat Res 2021; 479:1217-1223. [PMID: 33411452 PMCID: PMC8133223 DOI: 10.1097/corr.0000000000001635] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/14/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Musculoskeletal specialists who attempt to discuss the connection between mental health (thoughts and emotions) and physical health (symptom intensity and activity tolerance) with patients, may fear that they risk offending those patients. In a search for language that creates comfort with difficult conversations, some specialists favor a biomedical framework, such as central sensitization, which posits abnormal central neuron activity. Without addressing the relative accuracy of mind- or brain-based conceptualizations, we addressed crafted and practiced communication strategies as conversation starters that allow specialists to operate within a biopsychosocial framework without harming the relationship with the patient. QUESTIONS/PURPOSES We measured (1) patient resonance with various explanations of the mind-body connection, including examples of both mind- and brain-based communication strategies, and (2) factors associated with resonance and emotional reactions to the explanations. METHODS In this cross-sectional study, all adult new and returning patients who were literate in English and who attended several musculoskeletal specialty offices were invited to complete questionnaires addressing reactions to one of seven explanations of the mind-body connection assigned using a random number generator. Acknowledging that the relative accuracy of mind-based and nerve- or brain-based strategies are speculative, we developed the following conversation starters: two explanations that were cognitively framed ("the mind is a great story teller"; one positively framed and one negatively framed), two emotionally framed explanations ("stressed or down"; one positively framed and one negatively framed), one mentioning thoughts and emotions in more neutral terms ("mind and body work together … thoughts and emotions affect the way your body experiences pain"), and two biomedical neurophysiology-based explanations ("nerves get stuck in an over-excited state" and "overstimulated nerves"), all crafted with the assistance of a communication scholar. It was unusual for people to decline (although the exact number of those who did was not tracked) and 304 of 308 patients who started the questionnaires completed them and were analyzed. In this sample, 51% (155 of 304) were men, and the mean ± SD age was 49 ± 17 years. Reactions were measured as resonance (a 1 to 5 Likert scale regarding the degree to which the stated concept aligns with their understanding of health and by inference is a comfortable topic of discussion) and self-assessment manikins using circled figurines to measure feelings of happiness (frowning to smiling figures), stimulation/excitement (a relaxed sleepy figure to an energized wide-eyed figure), and security/control (small to large figures). These are commonly used to quantify the appeal and emotive content of a given message. Patients also completed surveys of demographics and mental health. Multilevel multivariable linear regression models were constructed to assess factors associated with resonance, happiness, excitement, and control. RESULTS Controlling for potential confounding variables such as demographics and mental health measures, a relatively neutral biopsychosocial explanation ("mind and body work together") had the greatest mean resonance (4.2 ± 0.8 versus 3.8 ± 0.9 for the other explanations; p < 0.01) and the largest regression coefficient for resonance (0.78 [95% confidence interval 0.41 to 1.15]). The next-most-resonant explanations were biomedical ("excitable nerves", "over-excited state"). Biopsychosocial explanations that mention stress, distress, or cognitive bias ("mind is a great storyteller") had lower resonance. People with greater unhealthy cognitive bias regarding pain (more catastrophic thinking) were less comfortable with all the explanations (lower resonance, regression coefficient -0.03 [95% CI -0.06 to -0.01]). Emotional reactions were relatively comparable with the exception that people felt less control and security with specific explanations such as "excitable nerves" and "mind is a great storyteller." CONCLUSION Crafted communication strategies allow musculoskeletal specialists to address health within the biopsychosocial paradigm without harming their relationship with the patient. CLINICAL RELEVANCE Musculoskeletal specialists may be the first clinicians to notice mental health opportunities. It may be helpful for them to develop and practice effective communication strategies that make mental health a comfortable topic of discussion.
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Affiliation(s)
- Amanda I. Gonzalez
- A. I. Gonzalez, J. T. P. Kortlever, D. Ring, M. Queralt, Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
- L. E. Brown, Center for Health Communication, Moody College of Communication, the University of Texas at Austin, Austin, TX, USA
| | - Joost T. P. Kortlever
- A. I. Gonzalez, J. T. P. Kortlever, D. Ring, M. Queralt, Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
- L. E. Brown, Center for Health Communication, Moody College of Communication, the University of Texas at Austin, Austin, TX, USA
| | - Laura E. Brown
- A. I. Gonzalez, J. T. P. Kortlever, D. Ring, M. Queralt, Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
- L. E. Brown, Center for Health Communication, Moody College of Communication, the University of Texas at Austin, Austin, TX, USA
| | - David Ring
- A. I. Gonzalez, J. T. P. Kortlever, D. Ring, M. Queralt, Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
- L. E. Brown, Center for Health Communication, Moody College of Communication, the University of Texas at Austin, Austin, TX, USA
| | - Mark Queralt
- A. I. Gonzalez, J. T. P. Kortlever, D. Ring, M. Queralt, Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
- L. E. Brown, Center for Health Communication, Moody College of Communication, the University of Texas at Austin, Austin, TX, USA
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Fritsch CG, Ferreira PH, Prior JL, Vesentini G, Schlotfeldt P, Eyles J, Robbins S, Yu S, Mills K, Taylor DA, Lambert TE, Clavisi O, Bywaters L, Chow CK, Redfern J, McLachlan AJ, Ferreira ML. TEXT4myBACK - The Development Process of a Self-Management Intervention Delivered Via Text Message for Low Back Pain. Arch Rehabil Res Clin Transl 2021; 3:100128. [PMID: 34179764 PMCID: PMC8212000 DOI: 10.1016/j.arrct.2021.100128] [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] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To develop a bank of text messages for a lifestyle-based self-management intervention for people with low back pain (LBP). DESIGN Iterative development process. SETTING Community and primary care. PARTICIPANTS Fifteen researchers, clinicians, and consumer representatives participated in the concept and initial content development phase. Twelve experts (researchers and clinicians) and 12 consumers participated in the experts and consumers review phase. Full study sample of participants was N=39. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We first conducted two 2-hour workshops to identify important domains for people with LBP, sources of content, appropriate volume, and timing of the messages. The messages were then drafted by a team of writers. Second, we invited expert researchers and clinicians to review and score the messages using a 5-item psychometric scale according to (1) the appropriateness of the content and (2) the likelihood of clinical effectiveness and to provide written feedback. Messages scoring ≤8 out of 10 points would be modified accordingly. Consumers were invited to review the messages and score them using a 5-item psychometric scale according to the utility of the content, the understanding of the content, and language acceptability and to provide feedback. Messages scoring ≤12 out of 15 points would be improved. RESULTS Exercise, education, mood, sleep, use of care, and medication domains were identified and 82 domain-specific evidence-based messages were written. Messages received a mean score of 8.3 out of 10 points by experts. Twenty-nine messages were modified accordingly. The mean score of the messages based on consumers feedback was of 12.5 out of 15 points. Thirty-six messages were improved. CONCLUSIONS We developed a bank of text messages for an evidence-based self-management intervention using a theory-based, iterative, codesign process with researchers, consumers, and clinicians. This article provides scientific support for future development of text message interventions within the pain field.
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Affiliation(s)
- Carolina G. Fritsch
- Faculty of Medicine and Health, The University of Sydney, Institute of Bone and Joint Research, The Kolling Institute, Sydney, Australia
| | - Paulo H. Ferreira
- Musculoskeletal Health Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Joanna L. Prior
- Faculty of Medicine and Health, The University of Sydney, Institute of Bone and Joint Research, The Kolling Institute, Sydney, Australia
| | - Giovana Vesentini
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | | | - Jillian Eyles
- Faculty of Medicine and Health, The University of Sydney, Institute of Bone and Joint Research, The Kolling Institute, Sydney, Australia
| | - Sarah Robbins
- Faculty of Medicine and Health, The University of Sydney, Institute of Bone and Joint Research, The Kolling Institute, Sydney, Australia
| | - Shirley Yu
- Faculty of Medicine and Health, The University of Sydney, Institute of Bone and Joint Research, The Kolling Institute, Sydney, Australia
| | - Kathryn Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Deborah A. Taylor
- Department of Physiotherapy, Royal North Shore Hospital, Sydney, Australia
| | - Tara E. Lambert
- Department of Physiotherapy, Royal North Shore Hospital, Sydney, Australia
| | | | | | - Clara K. Chow
- Westmead Applied Research Centre and Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Westmead Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Julie Redfern
- Westmead Applied Research Centre and Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andrew J. McLachlan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Manuela L. Ferreira
- Faculty of Medicine and Health, The University of Sydney, Institute of Bone and Joint Research, The Kolling Institute, Sydney, Australia
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Clinical guidelines and care pathway for management of low back pain with or without radicular pain. Joint Bone Spine 2021; 88:105227. [PMID: 34051387 DOI: 10.1016/j.jbspin.2021.105227] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/11/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To develop guidelines for low back pain management according to previous international guidelines and the updated literature. METHODS A report was compiled from a review of systematic reviews of guidelines published between 2013 and 2018 and meta-analysis of the management of low back pain published between 2015 and 2018. This report summarized the state-of-the-art scientific knowledge for each predefined area of the guidelines from a critical review of selected literature. A multidisciplinary panel of experts including 17 health professionals involved in low back pain management and 2 patient representatives formulated preliminary guidelines based on the compilation report and a care pathway. The compilation report and preliminary guidelines were submitted to 25 academic institutions and stakeholders for the consultation phase. From responses of academic institutions and stakeholders, the final guidelines were developed. For each area of the guidelines, agreement between experts was assessed by the RAND/UCLA method. RESULTS The expert panel drafted 32 preliminary recommendations including a care pathway, which was amended after academic institution and stakeholder consultation. The consensus of the multidisciplinary expert panel was assessed for each final guideline: 32 recommendations were assessed as appropriate; none was assessed as uncertain or inappropriate. Strong approval was obtained for 27 recommendations and weak for 5. CONCLUSION These new guidelines introduce several concepts, including the need to early identify low back pain at risk of chronicity to provide quicker intensive and multidisciplinary management if necessary.
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Soares Oliveira I, da Silva T, Costa LOP, Medeiros FC, Oshima RKA, de Freitas DG, Fukuda TY, Costa LDCM. The Long-Term Prognosis in People With Recent Onset Low Back Pain From Emergency Departments: An Inception Cohort Study. THE JOURNAL OF PAIN 2021; 22:1497-1505. [PMID: 34029687 DOI: 10.1016/j.jpain.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/30/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Abstract
Most studies investigating the course of recent-onset low back pain (LBP) included patients from primary care. We aimed to describe the prognosis in people with recent-onset LBP presenting to emergency departments (EDs) and to identify prognostic factors for nonrecovery. This inception cohort study with a 1-year follow-up recruited 600 consecutive acute LBP patients presenting to 4 EDs. The outcomes measured the days to recover from pain, recover from disability, return to previous work hours and duties, and complete recovery. Within 12 months, 73% of participants (95% confidence interval [CI] = 69-77) recovered from pain, 86% (95% CI = 82-90) recovered from disability, 79% (95% CI = 71-87) returned to previous work hours and duties, and 70% (95% CI = 66-74) completely recovered. The median recovery times were 67 days (95% CI = 54-80) to recover from pain, 37 days (95% CI = 31-43) to recover from disability, 37 days (95% CI = 25-49) to return to previous work hours and duties, and 70 days (95% CI = 57-83) to recover completely. Higher pain levels, a higher perceived risk of persistent LBP, more days of reduced activity due to LBP, more pain sites, and higher duration of LBP were associated with complete nonrecovery within 6 months. PERSPECTIVE: This information relates to prognosis and to likely recovery times for patients with recent-onset LBP in EDs. The findings also confirm previous factors associated with poor outcomes in patients with recent-onset LBP.
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Affiliation(s)
- Indiara Soares Oliveira
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Tatiane da Silva
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil.
| | | | - Flávia Cordeiro Medeiros
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Renan Kendy Ananias Oshima
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Diego Galace de Freitas
- Department of Physical Therapy, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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Mitham K, Mallows A, Yeowell G, Littlewood C. Management of recent onset tendon-related pain in a primary contact setting: A survey of practice. Musculoskeletal Care 2021; 20:86-98. [PMID: 33934483 DOI: 10.1002/msc.1556] [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: 03/22/2021] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Tendon-related pain is a common and debilitating condition that affects a wide range of people. To inform future research, it is important to understand healthcare professional's current practice. OBJECTIVES To describe the practice of First Contact Practitioners (FCPs) and Other Clinicians (OCs) for recent onset tendon pain in a primary contact setting. The secondary aim was to understand if practice differed between the locations of pain. DESIGN Cross-sectional online survey METHOD: The online survey asked for responses relating to one scenario of shoulder pain and one of Achilles pain. Except location of pain, the scenarios were identical. Responses were collected over a four-week period to December 2020. The Chi-Square test was used to analyse the difference in proportion of responses between FCPs and OCs, and between locations of pain. RESULTS 118 responses were received. Rotator Cuff Related Shoulder Pain (RCRSP) was preferred by 64/118 (54.2%) for the shoulder scenario. Achilles tendinopathy was the preferred term by 86/103 (83.5%) for the Achilles. FCPs were more likely to advise NSAIDs for both shoulder (p = 0.006) and Achilles (p = 0.046) scenarios than OCs. Amended duties were more likely to be advised for manual workers for the shoulder scenario compared to Achilles (p = <0.0001). CONCLUSION There were similarities in the management of recent onset tendon-related pain; the majority of respondents recommended against further investigations, steroid injections, and recommended exercise. Understanding whether these approaches are clinically effective requires further investigation.
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Affiliation(s)
- Kieran Mitham
- Dynamic Health, Physiotherapy Department, Cambridgeshire Community Services NHS Trust, Huntingdon, Cambridgeshire, UK
| | - Adrian Mallows
- School of Sport, Rehabilitation & Exercise Sciences, University of Essex, Colchester, UK
| | - Gillian Yeowell
- Department of Health Professions, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
| | - Chris Littlewood
- Department of Health Professions, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
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Rajasekaran S, Dilip Chand Raja S, Pushpa BT, Ananda KB, Ajoy Prasad S, Rishi MK. The catastrophization effects of an MRI report on the patient and surgeon and the benefits of 'clinical reporting': results from an RCT and blinded trials. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2069-2081. [PMID: 33748882 DOI: 10.1007/s00586-021-06809-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/05/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Inappropriate use of MRI leads to increasing interventions and surgeries for low back pain (LBP). We probed the potential effects of a routine MRI report on the patient's perception of his spine and functional outcome of treatment. An alternate 'clinical reporting' was developed and tested for benefits on LBP perception. METHODS In Phase-I, 44 LBP patients were randomized to Group A who had a factual explanation of their MRI report or Group B, who were reassured that the MRI findings showed normal changes. The outcome was compared at 6 weeks by VAS, PSEQ-2, and SF-12. In Phase-II, clinical reporting was developed, avoiding potential catastrophizing terminologies. In Phase-III, 20 MRIs were reported by both routine and clinical methods. The effects of the two methods were tested on four categories of health care professionals (HCP) who read them blinded on their assessment of severity of disease, possible treatment required, and the probability of surgery. RESULTS Both groups were comparable initial by demographics and pain. After 6 weeks of treatment, Group A had a more negative perception of their spinal condition, increased catastrophization, decreased pain improvement, and poorer functional status(p = significant for all). The alternate method of clinical reporting had significant benefits in assessment of lesser severity of the disease, shift to lesser severity of intervention and surgery in three groups of HCPs. CONCLUSION Routine MRI reports produce a negative perception and poor functional outcomes in LBP. Focussed clinical reporting had significant benefits, which calls for the need for 'clinical reporting' rather than 'Image reporting'.
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Affiliation(s)
- S Rajasekaran
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India.
| | - S Dilip Chand Raja
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | | | - Kumar Behera Ananda
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - Shetty Ajoy Prasad
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - Mugesh Kanna Rishi
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
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117
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Affiliation(s)
- Amanda M Hall
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland A1B 3V6, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland A1B 3V6, Canada
| | - Bradley Thorne
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland A1B 3V6, Canada
| | - Chris G Maher
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
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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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Kiel S, Raus C, Sierocinski E, Knauthe P, Chenot JF. Concordance of patient beliefs and expectations regarding the management of low back pain with guideline recommendations - a cross-sectional study in Germany. BMC FAMILY PRACTICE 2020; 21:275. [PMID: 33342429 PMCID: PMC7751122 DOI: 10.1186/s12875-020-01352-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/10/2020] [Indexed: 12/19/2022]
Abstract
Background Low back pain is a common reason for patients to seek medical care. Physician non-adherence to clinical guidelines has been observed. We investigated the extent to which patient expectations correspond to recommendations of the German national guideline for management of low back pain (G-LBP) and whether patient characteristics, history of LBP and previous treatment experience are associated with expectations. Methods A cross-sectional study including patients from 13 general practices was conducted. Data were collected using a questionnaire. Inverse probability weights were used to address non-response bias. Descriptive analysis and multivariate logistic regression models were performed. Results A total of 977 patients were included in analyses (median age 57 years, 39% male). 75% of patients reported experiencing LBP currently or within the last year. More than 65% indicated they would agree to forgo further examinations if their LBP was judged by their physician to be of no serious concern. This was associated with the highest level of education and no prior imaging, and negatively associated with good-to-poor health status and moderate-to-severe pain intensity. 40% of participants expected imaging. The highest educational level, female gender and no prior imaging were associated with a decreased expectation of imaging. 70% expected prescriptions for massages. Females, participants with good-to-poor health status, current LBP or LBP in the last 12 months had an increased expectation for massages. Expectations for injection therapy (45%) were mainly associated with previous injections. Expectations for physiotherapy (64%) were associated with female gender, lower educational level, good-to-poor health status, current LBP or in the last 12 months. The perspective that daily activities should be continued (66%) was associated with female gender and higher educational level. Participants who agreed to the statement ‘There is no effective treatment for LBP’ (11%) had a poor health status, current LBP and a severe pain intensity. Conclusion Patient views regarding LBP management are partially concordant with guideline recommendations and are strongly influenced by previous treatment experiences and education level. Exploration of patient expectations and experiences in LBP treatment may help minimize dissatisfaction of patients expecting treatments not endorsed by guidelines and simultaneously increase physician guideline adherence.
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Affiliation(s)
- Simone Kiel
- Department of General Practice, Institute of Community Medicine, University Medicine Greifswald, Fleischmannstraße 6, 17475, Greifswald, Germany.
| | - Christina Raus
- Department of General Practice, Institute of Community Medicine, University Medicine Greifswald, Fleischmannstraße 6, 17475, Greifswald, Germany
| | - Elizabeth Sierocinski
- Department of General Practice, Institute of Community Medicine, University Medicine Greifswald, Fleischmannstraße 6, 17475, Greifswald, Germany
| | | | - Jean-François Chenot
- Department of General Practice, Institute of Community Medicine, University Medicine Greifswald, Fleischmannstraße 6, 17475, Greifswald, Germany
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Cashin AG, Wand BM, O'Connell NE, Lee H, Bagg MK, O'Hagan E, Maher CG, Furlan AD, van Tulder MW, McAuley JH. Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews. Hippokratia 2020. [DOI: 10.1002/14651858.cd013815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Aidan G Cashin
- Prince of Wales Clinical School, Faculty of Medicine; The University of New South Wales; Sydney Australia
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Benedict M Wand
- School of Physiotherapy; The University of Notre Dame Australia; Fremantle Australia
| | - Neil E O'Connell
- Health Economics Research Group, Institute of Environment, Health and Societies, Department of Clinical Sciences; Brunel University London; Uxbridge UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS); University of Oxford; Oxford UK
- School of Medicine and Public Health; University of Newcastle; Newcastle Australia
| | - Matthew K Bagg
- Prince of Wales Clinical School, Faculty of Medicine; The University of New South Wales; Sydney Australia
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
- New College Village; University of New South Wales; Sydney Australia
| | - Edel O'Hagan
- Prince of Wales Clinical School, Faculty of Medicine; The University of New South Wales; Sydney Australia
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Christopher G Maher
- Sydney School of Public Health; The University of Sydney; Sydney Australia
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
| | | | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences; VU University Amsterdam; Amsterdam Netherlands
| | - James H McAuley
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
- School of Medical Sciences, Faculty of Medicine; University of New South Wales; Sydney Australia
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Assessment of the Quality of Mobile Applications (Apps) for Management of Low Back Pain Using the Mobile App Rating Scale (MARS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249209. [PMID: 33317134 PMCID: PMC7763508 DOI: 10.3390/ijerph17249209] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 12/14/2022]
Abstract
Digital health interventions may improve different behaviours. However, the rapid proliferation of technological solutions often does not allow for a correct assessment of the quality of the tools. This study aims to review and assess the quality of the available mobile applications (apps) related to interventions for low back pain. Two reviewers search the official stores of Android (Play Store) and iOS (App Store) for localisation in Spain and the United Kingdom, in September 2019, searching for apps related to interventions for low back pain. Seventeen apps finally are included. The quality of the apps is measured using the Mobile App Rating Scale (MARS). The scores of each section and the final score of the apps are retrieved and the mean and standard deviation obtained. The average quality ranges between 2.83 and 4.57 (mean 3.82) on a scale from 1 (inadequate) to 5 (excellent). The best scores are found in functionality (4.7), followed by aesthetic content (mean 4.1). Information (2.93) and engagement (3.58) are the worst rated items. Apps generally have good overall quality, especially in terms of functionality and aesthetics. Engagement and information should be improved in most of the apps. Moreover, scientific evidence is necessary to support the use of applied health tools.
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Ferri CM, Natoli S, Sanz-Ayan P, Magni A, Guerrero C, Lara-Solares A, Liedgens H, Thömmes G, Karra R. Quality of life and functional outcomes with tapentadol prolonged release in chronic musculoskeletal pain: post hoc analysis. Pain Manag 2020; 11:173-187. [PMID: 33241725 DOI: 10.2217/pmt-2020-0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Aims: To investigate quality of life (QOL) and functionality changes in chronic pain during tapentadol prolonged release (PR) treatment. Patients & methods: Post hoc analysis of data from three Phase III trials in patients with osteoarthritis knee pain or low back pain. QOL and functionality changes were assessed by SF-36 scores. Results: All SF-36 subdomain scores improved progressively to week 3 of tapentadol titration and were sustained during 12-week maintenance treatment. Improvements in SF-36 scores were similar between tapentadol dose groups (e.g., 200 to <300 mg vs ≥500 mg), with no greater effect from higher doses. QOL and functionality improvements were consistently greater with tapentadol PR than oxycodone controlled release. Conclusion: Tapentadol PR provides consistent, clinically relevant improvements in QOL and functionality in chronic pain.
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Affiliation(s)
| | - Silvia Natoli
- University of Rome Tor Vergata, Department of Clinical Science & Translational Medicine & Unit of Pain Therapy, Polyclinic of Tor Vergata, Rome, 00133, Italy
| | - Paz Sanz-Ayan
- Hospital Universitario 12 de Octubre; Department of Rehabilitation, Hospital Universitario 12 de Octubre, Madrid, 28041, Spain
| | - Alberto Magni
- Italian College of General Practitioners & Primary Care, Florence, 50141, Italy
| | - Carlos Guerrero
- Hospital Universitario Fundación Santa Fe, Bogotá 110121, Universidad de los Andes, Colombia
| | - Argelia Lara-Solares
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, 14080, Mexico
| | | | - Guido Thömmes
- R&D - Development - Data Sciences, Grünenthal GmbH, Aachen, 52099, Germany
| | - Ravi Karra
- Global Medical Affairs, Grünenthal GmbH, Aachen, 52099, Germany
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Zheluk A, Maddock J. Plausibility of Using a Checklist With YouTube to Facilitate the Discovery of Acute Low Back Pain Self-Management Content: Exploratory Study. JMIR Form Res 2020; 4:e23366. [PMID: 33216003 PMCID: PMC7718094 DOI: 10.2196/23366] [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] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background Access to guideline-consistent effective care for acute low back pain (ALBP) is generally regarded as limited. Researchers have recognized the potential of YouTube as a clinical and patient education resource that may improve access to appropriate care. However, the heterogeneity of evaluation approaches and variable quality of health information have generally limited the potential of YouTube as a self-management intervention. Objective This study aims to increase the understanding of ALBP content available on YouTube in 2020 and to establish the plausibility of using a simple checklist to facilitate the discovery of YouTube content consistent with current guidelines. We examined the following 4 research questions: how was the data set defined, what are the metadata characteristics of the videos in the data set, what is the information quality of ALBP YouTube videos, and what are the characteristics of the YouTube data set based on an ALBP self-management checklist? Methods This was an exploratory, qualitative infodemiology study. We identified videos in our data set through YouTube search based on popular ALBP-relevant search terms identified through Google Trends for YouTube. We accessed YouTube metadata using the YouTube data tools developed by the University of Amsterdam. We used a modified Brief DISCERN checklist to examine the information quality. We developed a checklist based on the 2018 Lancet Low Back Pain guidelines to examine self-management content. Results We analyzed a data set of 202 YouTube videos authored by chiropractors, physicians, physiotherapists, and instructors of yoga and other disciplines. We identified clear differences in the ALBP videos in our data set based on the authors’ disciplines. We found that the videos authored by each discipline strongly featured a specific intervention domain, that is, education, treatment, or exercise. We also found that videos authored by physicians were consistently coded with the highest ALBP self-management content scores than all other disciplines. Conclusions The results returned by YouTube in response to a search for back pain–related content were highly variable. We suggest that a simple checklist may facilitate the discovery of guideline-concordant ALBP self-management content on YouTube. Further research may identify the clinical contexts in which the use of an ALBP checklist with YouTube is feasible.
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Affiliation(s)
- Andrey Zheluk
- School of Biomedical Sciences, Charles Sturt University, Bathurst, Australia.,University of Sydney, Menzies Centre for Health Policy, Sydney, Australia
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Wewege MA, Bagg MK, Jones MD, McAuley JH. Analgesic medicines for adults with low back pain: protocol for a systematic review and network meta-analysis. Syst Rev 2020; 9:255. [PMID: 33148322 PMCID: PMC7643321 DOI: 10.1186/s13643-020-01506-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/19/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is limited evidence for the comparative effectiveness of analgesic medicines for adults with low back pain. This systematic review and network meta-analysis aims to determine the analgesic effect, safety, acceptability, effect on function, and relative rank according to analgesic effect, safety, acceptability, and effect on function of a single course of [an] analgesic medicine(s) or combination of these medicines for people with low back pain. METHODS We will include published and unpublished randomised trials written in any language that compare an analgesic medicine to either another medicine, placebo/sham, or no intervention in adults with low back pain, grouped according to pain duration: acute (fewer than 6 weeks), sub-acute (6 to 12 weeks), and chronic (greater than 12 weeks). The co-primary outcomes are pain intensity following treatment and safety (adverse events). The secondary outcomes are function and acceptability (all-cause dropouts). We will perform a network meta-analysis to compare and rank analgesic medicines. We will form judgements of confidence in the results using the Confidence in Network Meta-Analysis (CINeMA) methodology. DISCUSSION This network meta-analysis will establish which medicine, or combination of medicines, is most effective for reducing pain and safest for adults with low back pain. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019145257.
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Affiliation(s)
- Michael A. Wewege
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew K. Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052 Australia
- New College Village, University of New South Wales, Sydney, Australia
| | - Matthew D. Jones
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - James H. McAuley
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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Overcoming Overuse Part 2: Defining and Quantifying Health Care Overuse for Musculoskeletal Conditions. J Orthop Sports Phys Ther 2020; 50:588-591. [PMID: 33131396 DOI: 10.2519/jospt.2020.0109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this series on "Overcoming Overuse," we explore the issue of health care overuse and how it may be identified in musculoskeletal physical therapy. In part 2, we frame health care overuse as a continuum from overuse to appropriate care, and consider how to measure overuse. We describe how overuse can be defined within a framework of care that is ineffective, inefficient, and misaligned, depending on the perspective of the person delivering or receiving care-the clinician, society, or patient. To ensure that musculoskeletal health care is of high value and sustainable, we encourage physical therapists to reflect on their practice. J Orthop Sports Phys Ther 2020;50(11):588-591. doi:10.2519/jospt.2020.0109.
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Chi-Lun-Chiao A, Chehata M, Broeker K, Gates B, Ledbetter L, Cook C, Ahern M, Rhon DI, Garcia AN. Patients' perceptions with musculoskeletal disorders regarding their experience with healthcare providers and health services: an overview of reviews. Arch Physiother 2020; 10:17. [PMID: 32983572 PMCID: PMC7517681 DOI: 10.1186/s40945-020-00088-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/15/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives This overview of reviews aimed to identify (1) aspects of the patient experience when seeking care for musculoskeletal disorders from healthcare providers and the healthcare system, and (2) which mechanisms are used to measure aspects of the patient experience. Data sources Four databases were searched from inception to December 20th, 2019. Review methods Systematic or scoping reviews examining patient experience in seeking care for musculoskeletal from healthcare providers and the healthcare system were included. Independent authors screened and selected studies, extracted data, and assessed the methodological quality of the reviews. Patient experience concepts were compiled into five themes from a perspective of a) relational and b) functional aspects. A list of mechanisms used to capture the patient experience was also collected. Results Thirty reviews were included (18 systematic and 12 scoping reviews). Relational aspects were reported in 29 reviews and functional aspects in 25 reviews. For relational aspects, the most prevalent themes were “information needs” (education and explanation on diseases, symptoms, and self-management strategies) and “understanding patient expectations” (respect and empathy). For functional aspects, the most prevalent themes were patient’s “physical and environmental needs,” (cleanliness, safety, and accessibility of clinics), and “trusted expertise,” (healthcare providers’ competence and clinical skills to provide holistic care). Interviews were the most frequent mechanism identified to collect patient experience. Conclusions Measuring patient experience provides direct insights about the patient’s perspectives and may help to promote better patient-centered health services and increase the quality of care. Areas of improvement identified were interpersonal skills of healthcare providers and logistics of health delivery, which may lead to a more desirable patient-perceived experience and thus better overall healthcare outcomes. Trial registration Systematic review registration: PROSPERO (CRD42019136500).
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Affiliation(s)
- Alan Chi-Lun-Chiao
- Duke Department of Orthopedic Surgery, Duke University Division of Physical Therapy, Durham, North Carolina USA
| | - Mohammed Chehata
- Duke Department of Orthopedic Surgery, Duke University Division of Physical Therapy, Durham, North Carolina USA
| | - Kenneth Broeker
- Duke Department of Orthopedic Surgery, Duke University Division of Physical Therapy, Durham, North Carolina USA
| | - Brendan Gates
- Duke Department of Orthopedic Surgery, Duke University Division of Physical Therapy, Durham, North Carolina USA
| | - Leila Ledbetter
- Duke University Medical Center Library, Durham, North Carolina USA
| | - Chad Cook
- Duke Department of Orthopedic Surgery, Duke University Division of Physical Therapy, Duke Clinical Research Institute, Durham, North Carolina USA
| | - Malene Ahern
- University of Wollongong, Australian Health Services Research Institute, Sydney, New South Wales Australia
| | - Daniel I Rhon
- Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX USA
| | - Alessandra N Garcia
- College of Pharmacy & Health Sciences, Physical Therapy Program, Lillington, North Carolina USA
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Furlong B, Aubrey-Bassler K, Etchegary H, Pike A, Darmonkow G, Swab M, Hall A. Patient education materials for non-specific low back pain and sciatica: a protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e039530. [PMID: 32878763 PMCID: PMC7470487 DOI: 10.1136/bmjopen-2020-039530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Low back pain accounts for more disability than any other musculoskeletal condition and is associated with severe economic burden. Patients commonly present with negative beliefs about low back pain and this can have detrimental effects on their health outcomes. Providing evidence-based, patient-centred education that meets patient needs could help address these negative beliefs and alleviate the substantial low back pain burden. The primary aim of this review is to investigate the effectiveness of patient education materials on immediate process, clinical and health system outcomes. METHODS AND ANALYSIS The search strategy was developed in collaboration with a librarian and systematic searches will be performed in MEDLINE, EMBASE, CINAHL, PsycINFO and SPORTDiscus. We will also search trial registries and grey literature through the OpenGrey database. Study selection will include a title and abstract scan and full-text review by two authors. Only randomised controlled trials will be included in this review. Trials must include patients with low back pain or sciatica and investigate educational interventions with at least one of the following contrasts: (1) education alone versus no intervention; (2) education alone versus another intervention; (3) education in addition to another intervention versus the same intervention with no education. Data extraction, risk of bias and grading of the quality of evidence will be performed independently by two reviewers. Risk of bias will be assessed using the PEDro scale, and the quality of evidence will be assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach. A random-effects model will be used for each contrast, and results will be pooled if the participants, interventions, and outcomes are homogeneous. If heterogeneity is high (I2 >75%), we will evaluate the magnitude and direction of the differences in effect sizes across studies to determine if it remains reasonable to pool the results. Analyses of acute and subacute low back pain (less than 12 weeks duration) will be performed separately from chronic low back pain (12 weeks or greater duration). Likewise, analyses of short-term (less than 6 months) and long-term (6 months or greater) follow-up will be performed separately. Subgroup analyses will be performed on non-specific low back pain, sciatica and mixed populations. ETHICS AND DISSEMINATION Ethical approval is not required for this review. This study, along with its results, will be published in a peer-reviewed journal.
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Affiliation(s)
- Bradley Furlong
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Holly Etchegary
- Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Andrea Pike
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Georgia Darmonkow
- Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Michelle Swab
- Health Sciences Library, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland, Canada
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Thomson OP, Anstiss V. The development and exploratory analysis of the Osteopaths’ Therapeutic Approaches Questionnaire (Osteo-TAQ). INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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129
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Petrozzi MJ, Rubinstein SM, Ferreira PH, Leaver A, Mackey MG. Predictors of low back disability in chiropractic and physical therapy settings. Chiropr Man Therap 2020; 28:41. [PMID: 32782008 PMCID: PMC7422525 DOI: 10.1186/s12998-020-00328-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background Predicting ongoing disability for chronic non-specific low back pain (LBP) is important to avoid prolonged disability. Objective Determine predictors of disability at 6 month follow-up in patients with LBP at medium risk of ongoing disability. Methods Baseline data was collected from 108 patients with medium-risk chronic non-specific LBP (mean age 50.4 years, SD 13.6) from six private chiropractic and physiotherapy clinics in Australia who took part in a randomised control trial. All patients received a pragmatic course of multimodal physical treatments [e.g., manual therapy (spinal manipulation or mobilization and/or soft tissue massage)] combined with advice, education and exercise. Baseline prognostic variables included sociodemographic, physical and psychological characteristics. Primary outcome was disability (Roland Morris Disability) at 6 month follow-up. Multivariable linear regression analysis was conducted. Results Variables remaining in the final multivariable model: lower work ability (β = − 1.05, 95% CI − 1.40 to − 0.70; p < 0.0001) and consultation with a medical specialist for back pain in the preceding 3 months (β = 3.35, 95% CI 1.14 to 5.55; p < 0.003), which significantly predicted higher disability at 6 months (unadjusted R 2 = 0.31). Those with a lower work ability (scale 1 to 10) and who had seen a medical specialist for their back pain were more likely to report greater LBP-related disability at 6 months. Conclusion Patients with chronic LBP presenting to primary care with lower work ability and recent consultation with a medical specialist for LBP are more likely to have a worse prognosis; these are indicators to clinicians that standard conservative care may not adequately manage the patients’ needs.
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Affiliation(s)
- M John Petrozzi
- Faculty of Medicine and Health, University of Sydney, Rm S223, S Block, Sydney School of Health Sciences, Cumberland Campus NSW, Sydney, 2141, Australia.
| | - Sidney M Rubinstein
- Department of Health Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paulo H Ferreira
- Faculty of Medicine and Health, University of Sydney, Rm S223, S Block, Sydney School of Health Sciences, Cumberland Campus NSW, Sydney, 2141, Australia
| | - Andrew Leaver
- Faculty of Medicine and Health, University of Sydney, Rm S223, S Block, Sydney School of Health Sciences, Cumberland Campus NSW, Sydney, 2141, Australia
| | - Martin G Mackey
- Faculty of Medicine and Health, University of Sydney, Rm S223, S Block, Sydney School of Health Sciences, Cumberland Campus NSW, Sydney, 2141, Australia
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Strategies for a safe and assertive telerehabilitation practice. Braz J Phys Ther 2020; 25:113-116. [PMID: 32798201 PMCID: PMC7410814 DOI: 10.1016/j.bjpt.2020.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/29/2020] [Indexed: 12/20/2022] Open
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131
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Alhowimel A, Alotaibi M, Coulson N, Radford K. Psychosocial consequences of diagnosing nonspecific low-back pain radiologically: a qualitative study. Physiother Theory Pract 2020; 38:890-896. [PMID: 32746671 DOI: 10.1080/09593985.2020.1802799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic low back pain (CLBP) is a complex biopsychosocial problem with financial implications for society. Most LBP is categorized as nonspecific CLBP (NS-CLBP); magnetic resonance imaging (MRI) is increasingly used in the investigation of LBP but has a high false-positive rate for NS-CLBP. PURPOSE To explore the psychosocial factors associated with diagnosing NS-CLBP by MRI in Saudi Arabia. METHODS Using a qualitative design, 11 patients with CLBP without a clear medical diagnosis who had received an MRI scan were interviewed using a semi-structured technique, and transcripts were analyzed using framework analysis. RESULTS Four themes of relevance to the psychosocial consequences of using MRI to diagnose CLBP were identified: 1) impact on social participation after MRI diagnosis; 2) psychological impact of MRI diagnosis; 3) conflicting advice; and 4) patient education. Although some patients expressed a sense of relief following the identification of an objective explanation of their symptoms by MRI, a number of negative consequences were also identified. In particular, fear-avoidance behavior and anxiety were apparent. CONCLUSION The use of MRI scanning in the diagnosis of LBP may lead to psychosocial factors influencing participation in physical and social daily activities.
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Affiliation(s)
- Ahmed Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin AbdulAziz University, Alkarj, Saudi Arabia
| | - Mazyad Alotaibi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin AbdulAziz University, Alkarj, Saudi Arabia
| | - Neil Coulson
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kathryn Radford
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Pires D, Cruz EB, Costa D, Nunes C. Beyond pain and disability: an explanatory mixed methods study exploring outcomes after physiotherapy intervention in patients with chronic low back pain. Disabil Rehabil 2020; 44:882-891. [PMID: 32579037 DOI: 10.1080/09638288.2020.1781938] [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] [Indexed: 12/17/2022]
Abstract
Purpose: The primary aim of this study was to explore relevant outcome domains for patients with chronic low back pain (CLBP) undergoing physiotherapy. A secondary aim was to examine potential discrepancies between meaningful changes in pain and disability and the global perception of improvement.Methods: An explanatory mixed methods design was employed. Twenty-two patients with CLBP completed self-reported measures before and after a physiotherapy programme. After the intervention, three focus groups were conducted with patients who perceived an overall improvement. Discussions were recorded, transcribed and analysed using thematic analysis.Results: Quantitative analysis showed an inconsistent relationship between changes in pain and disability measures and global improvements as perceived by patients. Two main themes emerged from the thematic analysis: "pain relief" (subthemes: reducing pain intensity and other symptoms; reducing medication intake; improving sleep quality) and "gaining control over the LBP condition" (subthemes: ability to self-manage; return to function; and sense of well-being and normality).Conclusion: Patients with CLBP perceived multiple outcomes from physiotherapy treatment that cover the domains of global, physical, mental and social health. These study findings suggest that the targets of measurement for physiotherapy need to be expanded in order to reflect outcome domains valued by patients.Implications for rehabilitationMinimum important changes in pain intensity and disability were not valid indicators of global improvements as perceived by patients.Patients with chronic low back pain undergoing physiotherapy perceived gains in multiple health domains that ranged beyond pain and disability domains.Physiotherapy outcome assessment needs to integrate other patient-relevant outcomes such as medication intake, sleep quality, ability to self-manage and sense of well-being.
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Affiliation(s)
- Diogo Pires
- NOVA National School of Public Health, Public Health Research Centre NOVA University of Lisbon, Lisbon, Portugal.,Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Eduardo Brazete Cruz
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal.,Department of Physiotherapy, School of Health Care, Polytechnic Institute of Setúbal, Lisbon, Portugal
| | - Daniela Costa
- NOVA National School of Public Health, Public Health Research Centre NOVA University of Lisbon, Lisbon, Portugal.,Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Carla Nunes
- NOVA National School of Public Health, Public Health Research Centre NOVA University of Lisbon, Lisbon, Portugal.,Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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Gardner C, Moseley GL, Karran EL, Wiles LK, Hibbert P. Implementing high value back pain care in private physiotherapy in Australia: A qualitative evaluation of physiotherapists who participated in an "implementation to innovation" system. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2020; 4:86-102. [PMID: 33987488 PMCID: PMC7951159 DOI: 10.1080/24740527.2020.1732808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: Many barriers exist to delivering high-value care for people with low back pain (LBP). We have developed a multistrategy implementation system to overcome these barriers. Here we describe a qualitative evaluation of the experiences of private-sector physiotherapists implementing the system. Design: PRISM (Practice-based innovation and implementation system) is an iterative clinician-as-scientist implementation program, tailored here for acute and subacute LBP. PRISM integrates strategies from behavioral change, implementation, and educational science fields. Semistructured interviews, group discussion forums, and electronic questionnaires were used to collect data at multiple time points that were then analyzed using an interpretative descriptive approach. Participants: Six physiotherapists (purposive sample) practicing in private practice physiotherapy clinics in the Adelaide region, South Australia, were enrolled in the study. Interventions: Interventions included an educational pain science and care workshop incorporating self-regulated learning principles, a co-planned clinical pathway, an electronic decision support tool, development and support of a community of practice, case study simulations, audit and feedback, and collaborative problem solving and innovation for physiotherapists. Results: Participants’ experiences and perceptions centered around five themes: (1) knowledge and skills training; (2) networking and mentoring; (3) a clear clinical pathway; (4) practical tools; and (5) data feedback. Participants appraised the implementation process positively but identified patient receptiveness as a challenge at times. Suggestions for improvement included streamlining/automating data collection forms and processes and providing more simulation opportunities. Conclusions: PRISM appears to be a promising approach to overcoming several barriers that prevent people with back pain from receiving high-value care. It consolidates and increases pain science knowledge and increases physiotherapist confidence in delivering high-value care. It appears to legitimize some current practices, enhance clinical reasoning and communication skills, extend knowledge in line with contemporary pain science, and facilitate the application of a biopsychosocial management approach. The high-level acceptance by participants provides a foundation for further research to test outcomes and delivery in different settings. Contribution of the articleA quality improvement intervention designed to improve delivery of high-value care was well received by private practice physiotherapists. Physiotherapists particularly valued using experiential learning to improve fluency in communicating with, and educating patients about, contemporary pain science. A structured clinical pathway and tools guided physiotherapists on the basic elements of necessary care and allowed them to concentrate on higher levels of decision making and communication with patients.
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Affiliation(s)
- Claire Gardner
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia.,College of Nursing and Health Sciences, Flinders University of South Australia, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Emma L Karran
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Louise K Wiles
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Peter Hibbert
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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134
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Ford JJ, Kaddour O, Page P, Richards MC, McMeeken JM, Hahne AJ. A multivariate prognostic model for pain and activity limitation in people undergoing lumbar discectomy. Br J Neurosurg 2020; 34:381-387. [PMID: 32216592 DOI: 10.1080/02688697.2020.1742288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: The purpose of this study was to identify a multivariate predictive model for 6-month outcomes on overall pain, leg pain and activity limitation in patients undergoing lumbar discectomy. Identification of predictors of outcome for lumbar discectomy has the potential to assist identifying treatment targets, clinical decision making and disease understanding.Materials and methods: Prospective cohort design. Ninety-seven patients deemed by study surgeons to be suitable for lumbar discectomy completed a comprehensive clinical and radiological baseline assessment. At 6-months post surgery outcome measures of overall and leg pain (visual analogue scale) as well as activity limitation (Oswestry Disability Index) were completed. Univariate and multivariate analyses were conducted to determine the best multivariate predictive model of outcome.Results: In the multivariate model, presence of a compensation claim, longer duration of injury and presence of below knee pain and/or parasthesia were negative prognostic indicators for at least two of the outcomes. Peripheralization in response to mechanical loading strategies was a positive prognostic indicator for overall pain and leg pain. A range of other prognostic indicators for one outcome were also identified. The prognostic model explained up to 32% of the variance in outcome.Conclusions: An 11-factor prognostic model was identified from a range of clinically and radiologically assessed variables in accordance with a biopsychosocial model. The multivariate model has potential implications for researchers and practitioners in the field. Further high quality research is required to externally validate the prognostic model, evaluate effect of the identified prognostic factors on treatment effectiveness and explore potential mechanisms of effect.
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Affiliation(s)
- Jon J Ford
- College of Science, Health & Engineering, La Trobe University, Bundoora, Australia.,Advance Healthcare, Boronia, Australia
| | | | - Patrick Page
- Box Hill Radiology, Epworth Eastern Hospital, Box Hill, Australia
| | - Matthew C Richards
- College of Science, Health & Engineering, La Trobe University, Bundoora, Australia.,Advance Healthcare, Boronia, Australia
| | - Joan M McMeeken
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Australia
| | - Andrew J Hahne
- College of Science, Health & Engineering, La Trobe University, Bundoora, Australia
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Valenzuela-Pascual F, García-Martínez E, Molina-Luque F, Soler-González J, Blanco-Blanco J, Rubí-Carnacea F, Climent-Sanz C, Briones-Vozmediano E. Patients’ and primary healthcare professionals’ perceptions regarding chronic low back pain and its management in Spain: a qualitative study. Disabil Rehabil 2019; 43:2568-2577. [DOI: 10.1080/09638288.2019.1705923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Fran Valenzuela-Pascual
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | | | - Fidel Molina-Luque
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Department of Geography and Sociology, University of Lleida, Lleida, Spain
| | - Jorge Soler-González
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Department of Medicine, University of Lleida, Lleida, Spain
- Catalan Health Institute, Lleida, Spain
| | - Joan Blanco-Blanco
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Francesc Rubí-Carnacea
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Carolina Climent-Sanz
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Erica Briones-Vozmediano
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
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