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Simula AS, Malmivaara A, Booth N, Karppinen J. A classification-based approach to low back pain in primary care - protocol for a benchmarking controlled trial. BMC FAMILY PRACTICE 2020; 21:61. [PMID: 32252643 PMCID: PMC7137427 DOI: 10.1186/s12875-020-01135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/29/2020] [Indexed: 12/03/2022]
Abstract
Background Guidelines recommend a biopsychosocial framework for low back pain (LBP) management and the avoidance of inappropriate imaging. In clinical practice, care strategies are often inconsistent with evidence and guidelines, even though LBP is the most common disabling health condition worldwide. Unhelpful beliefs, attitudes and inappropriate imaging are common. LBP is understood to be a complex biopsychosocial phenomenon with many known multidimensional risk factors (symptom- and lifestyle-related, psychological and social) for persistent or prolonged disability, which should be identified and addressed by treatment. The STarT Back Tool (SBT) was developed for early identification of individual risk factors of LBP to enable targeted care. Stratified care according SBT has been shown to improve the effectiveness of care in a primary care setting. A biopsychosocially-oriented patient education booklet, which includes imaging guidelines and information, is one possible way to increase patients’ understanding of LBP and to reduce inappropriate imaging. Premeditated pathways, education of professionals, written material, and electronic patient registry support in health care organizations could help implement evidence-based care. Methods We will use a Benchmarking Controlled Trial (BCT) design in our study. We will prospectively collect data from three health care regions before and after the implementation of a classification-based approach to LBP in primary care. The primary outcome will be change in PROMIS (Patient-Reported Outcomes Measurement Information System) (short form 20a) over 12-month follow-up. Discussion The implementation of a classification-based biopsychosocial approach can potentially improve the care of LBP patients, reduce inappropriate imaging without increasing health-care costs, and decrease indirect costs by reducing work disability. Using the BCT we will be able to evaluate the effectiveness of the improvement strategy for the entire care pathway. Trial registration ISRCTN,ISRCTN13273552, retrospectively registered 13/05/2019.
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Affiliation(s)
- A S Simula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland. .,Department of General Medicine, The South Savo Social and Health Care Authority, Mikkeli, Finland.
| | - A Malmivaara
- Centre for Health and Social Economics, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - N Booth
- Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
| | - J Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
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152
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Task-Specific Sensitivity in Physical Function Testing Predicts Outcome in Patients With Low Back Pain. J Orthop Sports Phys Ther 2020; 50:206-213. [PMID: 31663814 DOI: 10.2519/jospt.2020.8953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the prognostic value of task-specific sensitivity in patients with low back pain by exploring whether task-specific sensitivity during physical function testing was associated with self-reported change in pain and disability. DESIGN Prospective cohort study nested in a randomized controlled trial. METHODS The study included 260 patients with low back pain, referred for evaluation in a secondary care setting. All patients completed questionnaires and underwent clinical examination by a physical therapist. Patients rated their pain intensity before and after completing a test battery measuring physical function and were classified into 4 categories-worse, unchanged, better, or no pain-depending on their pain response. At 3-month follow-up, outcomes were obtained by a postal questionnaire. RESULTS Task-specific sensitivity significantly predicted pain, after adjusting for known prognostic factors. Patients in the no pain, better, and unchanged groups improved their pain score significantly more than patients in the worse pain group. Patients in the no pain group also improved their disability score significantly more compared to patients in the worse pain group, after adjusting for known prognostic factors. CONCLUSION Task-specific sensitivity predicted pain intensity after 3 months in patients with low back pain. The prognostic value appears limited with respect to disability. J Orthop Sports Phys Ther 2020;50(4):206-213. Epub 30 Oct 2019. doi:10.2519/jospt.2020.8953.
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153
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Zaina F, Balagué F, Battié M, Karppinen J, Negrini S. Low back pain rehabilitation in 2020: new frontiers and old limits of our understanding. Eur J Phys Rehabil Med 2020; 56:212-219. [PMID: 32214063 DOI: 10.23736/s1973-9087.20.06257-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Low back pain (LBP) is the most common musculoskeletal condition affecting the quality of life of individuals, especially if persistent. Over the decades, a lot of work has been done in an attempt to reduce the negative impact of back pain, and help patients recover and maintain a better quality of life. New insights are coming from different fields of research, with a lot of work being done in searching for the etiology of LBP, describing the different phenotypes of symptomatic spines, and identifying factors involved in the persistence of the disease. Nevertheless, still a lot remains to be done to fully understand the problem of back pain and its causes. Even today, there appears to be a wide gap between basic science and applied rehabilitation research on LBP. The first is still searching in many different ways for the "holy grail" of the pain generator and providing very interesting results with particular relevance to surgical, drug-related and other biological approaches, while the second is pragmatically focusing on modifiable factors that may influence back pain outcomes. Yet, personalized, effective spine care has not been fully realized. While we recognize the potential of basic science advances, there is an immediate need for more translational rehabilitation research, as well as studies focused on the effectiveness of rehabilitation approaches.
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Affiliation(s)
- Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy -
| | - Federico Balagué
- Department of Rheumatology, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland
| | - Michele Battié
- Faculty of Health Sciences and Western's Bone and Joint Institute, Western University, London, ON, Canada
| | - Jaro Karppinen
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland.,Rehabilitation Unit of South Karelia Social and Health Care District, Oulu, Finland
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, "La Statale" University, Milan, Italy.,IRCCS Galeazzi Orthopedic Institute, Milan, Italy
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154
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Abstract
Musculoskeletal symptoms, including pain, are often experienced by musicians at all levels. These symptoms may have a detrimental impact on musicians' personal and work lives, and may also impact upon the ensembles they work within. Providing musicians with appropriate, evidence-based advice regarding pain management is therefore paramount. In this review, we aim to improve the advice given to musicians regarding playing when in pain, by answering the question 'should musicians play in pain?'. This multidisciplinary narrative review draws upon contemporary pain science, including factors associated with poorer prognoses for those in pain, as well as the reported experiences of musicians with pain (including those who have taken time off from playing). Our current understanding of pain science provides further support for the potential for consequences related to avoiding activities due to pain. Pain is modulated by a number of neuro-immunological processes and is influenced by a range of psychosocial factors. Taking time off from playing might therefore not have any benefit. Importantly, one of the leading causes of a transition from acute to chronic pain is fear-avoidance behaviour (e.g. not playing when in pain); hence, encouraging such behaviour cannot be supported. Musicians who have taken time off from playing due to pain have experienced a range of consequences, including emotional and financial consequences. These experiences indicate that there are potential negative consequences related to taking time off from playing which need to be weighed against any benefits. We conclude that musicians should not necessarily be advised to take time off from playing to manage their pain, in keeping with current best practice for pain management. Instead, we recommend that musicians be educated on contemporary pain science and when to seek treatment from a health professional for individualised advice to reduce the burden of musicians' pain.
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Affiliation(s)
- Jessica Stanhope
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Philip Weinstein
- School of Biological Sciences, The University of Adelaide, Adelaide, SA, Australia
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155
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Cross-cultural adaptation and validity of the Spanish fear-avoidance components scale and clinical implications in primary care. BMC FAMILY PRACTICE 2020. [PMID: 32106823 DOI: 10.1186/s12875‐020‐01116‐x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pain-related fear-avoidance (FA) is a common problem affecting many patients with painful medical conditions. As there is great interest in the clinical importance of the relationship between FA and disability, several questionnaires have been developed to measure FA. The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument that addresses critical issues not previously considered in previous FA-related questionnaires. The original English version of the FACS demonstrated good reliability, internal consistency, and construct, criterion, and predictive validity. Two factors were determined: General Fear Avoidance and Types of Activities That are Avoided. The aim of this study was to to translate the FACS into European-style Spanish (FACS-Sp), and validate its psychometric properties. METHODS This two-stage psychometric study included 330 subjects with various chronic musculoskeletal pain disorders. An initial translation and cross-cultural adaptation of the FACS, from English to Spanish, was performed. Then, critical psychometric properties were analysed, including internal consistency by Cronbach's α coefficients, structural validity from the Maximum Likelihood Extraction (MLE), and convergent validity by Pearson correlation with the Central Sensitization Inventory (CSI). RESULTS This study reports for the first time the psychometric properties of the Spanish version of the FACS. Total scores ranged from 0 to 88 points, with a mean of 30.49 (±17.18). The FACS-Sp showed a high internal consistency for factor 1 (α = 0.902) and factor 2 (α = 0.88). Factor structure was two-dimensional and supported structural validity, accounting for 48.75% of the total variance. Convergent validity analysis found a significant Pearson correlation r = 0.414. CONCLUSION This study reports for the first time the psychometric properties of the Spanish version of the FACS-Sp. Psychometric properties supported the validation of FACS-Sp and ensured the conceptual equivalence with the original English version. In primary care and chronic pain rehabilitation, FA assessment is crucial for clinical decision-making and treatment guidance. The FACS-Sp offers a new measure of FA in Spanish speaking populations. Future research on the FACS-Sp should evaluate test-retest reliability, treatment responsiveness and psychometric comparisons with other translated versions.
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156
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Cuesta-Vargas AI, Neblett R, Gatchel RJ, Roldán-Jiménez C. Cross-cultural adaptation and validity of the Spanish fear-avoidance components scale and clinical implications in primary care. BMC FAMILY PRACTICE 2020; 21:44. [PMID: 32106823 PMCID: PMC7047382 DOI: 10.1186/s12875-020-01116-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/21/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pain-related fear-avoidance (FA) is a common problem affecting many patients with painful medical conditions. As there is great interest in the clinical importance of the relationship between FA and disability, several questionnaires have been developed to measure FA. The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument that addresses critical issues not previously considered in previous FA-related questionnaires. The original English version of the FACS demonstrated good reliability, internal consistency, and construct, criterion, and predictive validity. Two factors were determined: General Fear Avoidance and Types of Activities That are Avoided. The aim of this study was to to translate the FACS into European-style Spanish (FACS-Sp), and validate its psychometric properties. METHODS This two-stage psychometric study included 330 subjects with various chronic musculoskeletal pain disorders. An initial translation and cross-cultural adaptation of the FACS, from English to Spanish, was performed. Then, critical psychometric properties were analysed, including internal consistency by Cronbach's α coefficients, structural validity from the Maximum Likelihood Extraction (MLE), and convergent validity by Pearson correlation with the Central Sensitization Inventory (CSI). RESULTS This study reports for the first time the psychometric properties of the Spanish version of the FACS. Total scores ranged from 0 to 88 points, with a mean of 30.49 (±17.18). The FACS-Sp showed a high internal consistency for factor 1 (α = 0.902) and factor 2 (α = 0.88). Factor structure was two-dimensional and supported structural validity, accounting for 48.75% of the total variance. Convergent validity analysis found a significant Pearson correlation r = 0.414. CONCLUSION This study reports for the first time the psychometric properties of the Spanish version of the FACS-Sp. Psychometric properties supported the validation of FACS-Sp and ensured the conceptual equivalence with the original English version. In primary care and chronic pain rehabilitation, FA assessment is crucial for clinical decision-making and treatment guidance. The FACS-Sp offers a new measure of FA in Spanish speaking populations. Future research on the FACS-Sp should evaluate test-retest reliability, treatment responsiveness and psychometric comparisons with other translated versions.
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Affiliation(s)
- Antonio I. Cuesta-Vargas
- Department of Physiotherapy of the Faculty of Health Science at the University of Malaga, Cátedra de Fisioterapia, Universidad de Málaga, Andalucía Tech, Av/ Arquitecto Peñalosa, 3 (Teatinos Campus Expansión), Malaga, 29071 Spain
- School of Clinical Science, Faculty of Health at the Queensland University of Technology, Brisbane, Australia
- Instituto Investigación de Biomédica de Málaga (IBIMA), Málaga, Spain
| | | | - Robert J. Gatchel
- Department of Psychology, Center of Excellence for the Study of Health & Chronic Illnesses, College of Science, The University of Texas at Arlington, Arlington, TX USA
| | - Cristina Roldán-Jiménez
- Department of Physiotherapy of the Faculty of Health Science at the University of Malaga, Cátedra de Fisioterapia, Universidad de Málaga, Andalucía Tech, Av/ Arquitecto Peñalosa, 3 (Teatinos Campus Expansión), Malaga, 29071 Spain
- Instituto Investigación de Biomédica de Málaga (IBIMA), Málaga, Spain
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157
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Yeh CH, Li C, Glick R, Schlenk EA, Albers K, Suen LKP, Lukkahatai N, Salen N, Pandiri S, Ma W, Perrin N, Morone NE, Christo PJ. A prospective randomized controlled study of auricular point acupressure to manage chronic low back pain in older adults: study protocol. Trials 2020; 21:99. [PMID: 31959226 PMCID: PMC6972012 DOI: 10.1186/s13063-019-4016-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/19/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chronic low back pain (cLBP) is a major health problem and the most common pain condition among those aged 60 years or older in the US. Despite the development of pharmacological and nonpharmacological interventions, cLBP outcomes have not improved and disability rates continue to rise. This study aims to test auricular point acupressure (APA) as a non-invasive, nonpharmacological self-management strategy to manage cLBP and to address current shortcomings of cLBP treatment. METHODS/DESIGN For this prospective randomized controlled study, participants will be randomly assigned to three groups: (1) APA group (active points related to cLBP), (2) Comparison group-1 (non-active points, unrelated to cLBP), and (3) Comparison group-2 (enhanced educational control, an educational booklet on cLBP will be given and the treatment used by participants for their cLBP will be recorded). The ecological momentary assessment smartphone app will be used to collect real-time cLBP outcomes and adherence to APA practice. Treatment and nonspecific psychological placebo effects will be measured via questionnaires for all participants. This proposed trial will evaluate the APA sustained effects for cLBP at 12-month follow-up. Monthly telephone follow-up will be used to collect study outcomes. Blood will be collected during study visits at baseline, post APA treatment, and follow-up study visits at 1, 3, 6, 9 and 12 months post completion of treatment for a total of seven assessments. Appointments will start between 9 and 11 am to control for circadian variation in cytokine levels. DISCUSSION This study is expected to provide vital information on the efficacy, sustainability, and underlying mechanism of APA on cLBP necessary for APA to gain acceptance from both healthcare providers and patients, which would provide a strong impetus for including APA as part of cLBP management in clinical and home settings. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03589703. Registered on 22 May 2018.
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Affiliation(s)
- Chao Hsing Yeh
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Room 421, Baltimore, MD, 21205, USA.
| | - Cuicui Li
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Room 421, Baltimore, MD, 21205, USA
| | - Ronald Glick
- Departments of Psychiatry, Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Kathryn Albers
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Nada Lukkahatai
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Room 421, Baltimore, MD, 21205, USA
| | - Nicole Salen
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Room 421, Baltimore, MD, 21205, USA
| | - Sonaali Pandiri
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Room 421, Baltimore, MD, 21205, USA
| | - Weixia Ma
- Shandong Provincial Hospital Affiliated to Shandong University,, Jinan, China
| | - Nancy Perrin
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Room 421, Baltimore, MD, 21205, USA
| | - Natalia E Morone
- Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Paul J Christo
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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158
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Association of STarT Back Tool and the short form of the Örebro Musculoskeletal Pain Screening Questionnaire with multidimensional risk factors. Sci Rep 2020; 10:290. [PMID: 31937867 PMCID: PMC6959304 DOI: 10.1038/s41598-019-57105-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 12/23/2019] [Indexed: 11/13/2022] Open
Abstract
The Short form of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-short) and the STarT Back Tool (SBT) have been developed to screen for risk factors for future low back pain (LBP) -related disability and work loss respectively. The aim of this study was to investigate the accordance of the two questionnaires and to evaluate the accumulation of risk factors in the risk groups of both screening tools in a large population-based sample. The study population consisted of 3079 participants of the Northern Finland Birth Cohort 1966 who had reported LBP over the previous 12 months and had SBT and ÖMPSQ-short data. We evaluated the association of depressive and anxiety symptoms (Hopkins symptom check list-25, Generalized anxiety disorder 7 questionnaire, and Beck’s Depression Inventory 21), psychological features (Fear-Avoidance Beliefs Questionnaire), lifestyle characteristics (BMI, smoking, alcohol abuse, physical inactivity) and social factors (education level) with the SBT and ÖMPSQ-short risk groups. The high-risk groups of both questionnaires were associated (p < 0.001) with depressive and anxiety symptoms and fear-avoidance beliefs. In addition, adverse lifestyle factors accumulated in the higher risk groups, especially from the ÖMPSQ-short. Agreement between the two questionnaires was moderate for men and fair for women.
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159
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Kuhnow A, Kuhnow J, Ham D, Rosedale R. The McKenzie Method and its association with psychosocial outcomes in low back pain: a systematic review. Physiother Theory Pract 2020; 37:1283-1297. [PMID: 31910720 DOI: 10.1080/09593985.2019.1710881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Study Design: Systematic Literature Review.Background: The McKenzie Method (MDT) is a comprehensive conservative approach commonly used for the management of low back pain (LBP); however, its association with psychosocial outcomes in this population is less clear.Objectives: Evaluate whether MDT has an association with psychosocial outcomes for individuals with LBP.Methods: The following electronic databases were searched: Medline, Pubmed, Cochrane, CINAHL, Embase and AMED. They were systematically searched from the date of inception to August 2019. Included studies had to have participants experiencing LBP who were over 18 years old, utilize MDT as an assessment or intervention, and report outcomes for at least one psychosocial variable. Three reviewers independently evaluated methodological quality of randomized control trials (RCT) using the PEDro scale and observational studies using the GRACE scale.Results: The initial search resulted in 181 articles to review. After screening abstracts, then full articles, a total of 16 studies were included, 5 of which were RCTs rated 5-8/10 on the PEDro scale. A qualitative review was performed and the studies' results were synthesized into five main findings: fear-avoidance beliefs, depression symptoms, pain self-efficacy, psychological distress, and return to work (RTW).Conclusions: There is evidence that MDT has an association with improving fear-avoidance beliefs, pain self-efficacy, depression, and psychological distress. These results should be interpreted with caution as further high-quality randomized control trials addressing this topic are necessary due to the varying methodological and statistical constructs of the included studies.
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Affiliation(s)
- Alexi Kuhnow
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | - David Ham
- Private Practice, Halifax, Nova Scotia, Canada
| | - Richard Rosedale
- London Health Sciences Centre, University Hospital, London, Ontario, Canada
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160
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Action observation as a treatment option for fear avoidance behavior in chronic spinal pain. Med Hypotheses 2020; 137:109535. [PMID: 31901606 DOI: 10.1016/j.mehy.2019.109535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 11/22/2022]
Abstract
Psychological factors play an essential role in the maintenance of various chronic pain states, with fear avoidance beliefs contributing to significant functional limitation and disability in chronic spinal pain. Fear avoidance behaviors are typically managed with cognitive-behavioral interventions such as graded exposure to feared movements and graded activity programs. However, attempts to make patients with high pain-related fear perform painful actions using graded exposure therapy can be very challenging. These fear avoidance beliefs in individuals with pain are usually acquired through previous pain experiences, observation, and threating verbal input from others that movement is harmful to the spinal structures. Observational learning of fear has been recently demonstrated in several experimental studies, where participants acquired fear of pain after observing the distressed painful expressions of the volunteers performing a painful cold pressor task. The primary purpose of this paper is to propose action observation, a cognitive rehabilitation technique, as one of the treatment options for reducing fear avoidance behavior in chronic spinal pain. Action observation involves the visualization of others performing a movement or an action to influence motor behavior positively and is mainly used in stroke rehabilitation. The paper hypothesizes that the pain-related fear of movement may be reduced through observation of others performing threatening movements successfully without displaying pain or discomfort. Action observation of others successfully executing a strenuous task may break the preexisting cognitive association between movement and pain among patients with high pain-related fear. Other possible mechanisms through which observation may influence pain-related fear could be the activation of mirror neuron systems and subsequent modulation of nociceptive information through the interconnections between the amygdala (one of the brain centers for fear), descending pain modulatory system and higher cortical centers. Few initial studies that investigated the effects of action observation on other outcomes of pain, such as pain severity are described to review the hypothesis. Considering the influence of observational learning on pain-related fear, action observation may be explored as potential adjunctive treatment to reduce fear avoidance behavior in chronic spinal pain.
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161
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Simula AS, Jenkins HJ, Holopainen R, Oura P, Korniloff K, Häkkinen A, Takala EP, Hancock MJ, Karppinen J. Transcultural adaption and preliminary evaluation of "understanding low back pain" patient education booklet. BMC Health Serv Res 2019; 19:1010. [PMID: 31888605 PMCID: PMC6936060 DOI: 10.1186/s12913-019-4854-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 12/20/2019] [Indexed: 12/21/2022] Open
Abstract
Background Low back pain (LBP) is the number one cause of disability globally. LBP is a symptom associated with biological, psychological and social factors, and serious causes for pain are very rare. Unhelpful beliefs about LBP and inappropriate imaging are common. Practitioners report pressure from patients to provide inappropriate imaging. A recently developed patient education and management booklet, ‘Understanding low back pain’, was designed to target previously identified barriers for reducing inappropriate imaging. The booklet includes evidence-based information on LBP and supports communication between patients and practitioners. Our aim was to 1) describe the translation process into Finnish and 2) study patients’ and practitioners’ attitudes to the booklet and to evaluate if it improved patients’ understanding of LBP and practitioners’ ability to follow imaging guidelines. Methods We translated the booklet from English to Finnish. Preliminary evaluation of the booklet was obtained from LBP patients (n = 136) and practitioners (n = 32) using web-based questionnaires. Open-ended questions were analysed using thematic analysis. Results Approximately half of the patients reported that reading the booklet helped them to understand LBP, while a third thought it encouraged them to perform physical activity and decreased LBP-related fear. Eighty percent of practitioners reported that the booklet helped them to follow imaging guidelines. In addition, practitioners reported that they found the booklet helpful and that it decreased the need for imaging. Conclusions The booklet seemed to be helpful in LBP management and in decreasing the need for LBP imaging according to patients and practitioners. Further research on the clinical effectiveness of the booklet in controlled study settings is needed. Trial registration ISRCTN, ISRCTN14389368, Registered 4 April 2019 - Retrospectively registered; ISRCTN11875357, Registered 22 April 2019 - Retrospectively registered.
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Affiliation(s)
- Anna Sofia Simula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland. .,Faculty of Medicine, Center for Life Course Health Research, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland. .,Department of General Medicine Mikkeli Central Hospital (Essote), Mikkeli, Finland.
| | - Hazel J Jenkins
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Balaclava Road, North Ryde, NSW, 2109, Australia.,Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Riikka Holopainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, FI-40014, Jyväskylä, Finland
| | - Petteri Oura
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Faculty of Medicine, Center for Life Course Health Research, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
| | - Katariina Korniloff
- School of Health and Social Studies, JAMK University of Applied Sciences, PO BOX 207, FI-40101, Jyväskylä, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, FI-40014, Jyväskylä, Finland.,Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Esa-Pekka Takala
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00032, Helsinki and Oulu, Työterveyslaitos, Finland
| | - Mark J Hancock
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Balaclava Road, North Ryde, NSW, 2109, Australia
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Faculty of Medicine, Center for Life Course Health Research, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.,Finnish Institute of Occupational Health, P.O. Box 40, FI-00032, Helsinki and Oulu, Työterveyslaitos, Finland
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162
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Kasatkin DS. [Acute back pain: minimizing the risks of therapy as the basis for effective treatment]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:80-85. [PMID: 31851177 DOI: 10.17116/jnevro201911911180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dorsopathies are one of the most common pathologies in the practice of a neurologist and therapist. Lower back pain as a leader in years lived with disability. Clinical differential diagnosis using red flags can significantly reduce the proportion of patients with unreasonable examinations. Stratifying patients for the risk of chronic pain and delayed recovery also reduces the risks of prolonged NSAID therapy. Identification of risk groups for cardiovascular and gastrointestinal complications and differentiated prescription of drugs helps to reduce the risks of therapy.
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Affiliation(s)
- D S Kasatkin
- Yaroslavl State Medical University, Yaroslavl, Russia
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163
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Suman A, Schaafsma FG, van Dongen JM, Elders PJM, Buchbinder R, van Tulder MW, Anema JR. Effectiveness and cost-utility of a multifaceted eHealth strategy to improve back pain beliefs of patients with non-specific low back pain: a cluster randomised trial. BMJ Open 2019; 9:e030879. [PMID: 31811006 PMCID: PMC6924789 DOI: 10.1136/bmjopen-2019-030879] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess the effectiveness and cost-utility of a multifaceted eHealth strategy compared to usual care in improving patients' back pain beliefs, and in decreasing disability and absenteeism. DESIGN Stepped-wedge cluster randomised trial with parallel economic evaluation. SETTING Dutch primary healthcare. PARTICIPANTS Patients diagnosed with non-specific low back pain by their general practitioner or physiotherapist. Patients with serious comorbidities or confirmed pregnancy were excluded. 779 patients were randomised into intervention group (n=331, 59% female; 60.4% completed study) or control group (n=448, 57% female; 77.5% completed study). INTERVENTIONS The intervention consisted of a multifaceted eHealth strategy that included a (mobile) website, digital monthly newsletters, and social media platforms. The website provided information about back pain, practical advice (eg, on self-management), working and returning to work with back pain, exercise tips, and short video messages from healthcare providers and patients providing information and tips. The control consisted of a digital patient information letter. Patients and outcome assessors were blinded to group allocation. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was back pain beliefs. Secondary outcome measures were disability and absenteeism, and for the preplanned economic evaluation quality of life and societal costs were measured. RESULTS There were no between-group differences in back pain beliefs, disability, or absenteeism. Mean intervention costs were €70- and the societal cost difference was €535-in favour of the intervention group, but no significant cost savings were found. The incremental cost-effectiveness ratio indicated that the intervention dominated usual care and the probability of cost-effectiveness was 0.85 on a willingness-to-pay of €10.000/quality adjusted life year (QALY). CONCLUSIONS A multifaceted eHealth strategy was not effective in improving patients' back pain beliefs or in decreasing disability and absenteeism, but showed promising cost-utility results based on QALYs. TRIAL REGISTRATION NUMBER NTR4329.
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Affiliation(s)
- Arnela Suman
- Department of Public and Occupational Health, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Frederieke G Schaafsma
- Department of Public and Occupational Health, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Petra J M Elders
- Department of Public and Occupational Health, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
| | - Rachelle Buchbinder
- Department of Clinical Epidemiology, Monash University, Clayton, Victoria, Australia
| | - Maurits W van Tulder
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes R Anema
- Department of Public and Occupational Health, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
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164
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Innes S, Jackson J. Musculoskeletal ultrasound imaging - An exploration of physiotherapists' interests and use in practice. Musculoskelet Sci Pract 2019; 44:102068. [PMID: 31585403 DOI: 10.1016/j.msksp.2019.102068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Musculoskeletal ultrasound imaging (MSKUSI) has gained popularity; several professions have expressed an interest in this application but the clinical use by physiotherapists has not been fully researched. OBJECTIVES To explore physiotherapists' interests and use of MSKUSI in practice. DESIGN Sequential mixed-methods; questionnaire followed by semi-structured interviews. METHOD A questionnaire was developed and distributed to gain initial information, (75 responses). Analysis informed topic-guide development and enabled a purposive-sampling strategy for semi-structured interviews that explored physiotherapists' interests, education and clinical use of MSKUSI (n = 11). Interview data were analysed thematically. RESULTS Five themes were identified: 1. Professional skill set - physiotherapists' suitability for MSKUSI. 2. Factors that have impacted physiotherapists' ability to use MSKUSI. 3. Physiotherapists' motivation to use ultrasound - improving patient focused care. 4. Quality assurance strategies. 5. Application of biopsychosocial model. Themes revealed links between physiotherapists' core skills, knowledge and professional experiences that align with MSKUSI requirements. Some participants reported support accessing education but many described challenges finding appropriate mentorship. Participants observed education did not always reflect practice typical of physiotherapists. Application of clinical reasoning processes utilised by physiotherapists was regarded as integral to patient-focused scanning. CONCLUSIONS Physiotherapists' professional training and musculoskeletal practice are seen as a foundation for education in MSKUSI. Accessing education can be challenging, in particular mentorship that fully incorporates the biopsychosocial model. Proposed roles for MSKUSI for physiotherapists include verification of clinical assessment findings for diagnosis and facilitation of patient education. The potential to streamline patient pathways and optimise resource management warrants investigation.
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Affiliation(s)
- Sue Innes
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex. Wivenhoe Park, Colchester, CO4 3SQ, United Kingdom.
| | - Jo Jackson
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex. Wivenhoe Park, Colchester, CO4 3SQ, United Kingdom.
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165
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Seminowicz DA, Thapa T, Schabrun SM. Corticomotor Depression is Associated With Higher Pain Severity in the Transition to Sustained Pain: A Longitudinal Exploratory Study of Individual Differences. THE JOURNAL OF PAIN 2019; 20:1498-1506. [DOI: 10.1016/j.jpain.2019.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/03/2019] [Accepted: 06/01/2019] [Indexed: 12/19/2022]
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166
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Khan JS, Shah R, Gilron I. Outcomes in Pain Clinical Research: What Really Matters for Patients? CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00361-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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167
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Ahenkorah J, Moffatt F, Diver C, Ampiah PK. Chronic low back pain beliefs and management practices in Africa: Time for a rethink? Musculoskeletal Care 2019; 17:376-381. [PMID: 31419001 DOI: 10.1002/msc.1424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Chronic low back pain (CLBP) beliefs are important psychosocial risk factors affecting the occurrence and progression of CLBP. To address pain beliefs and implement recommended biopsychosocial approaches for CLBP management, an understanding of the beliefs of patients and healthcare professionals (HCPs), and also CLBP management practices, is necessary. A narrative review was conducted to explore CLBP beliefs and practices in African countries. METHODS Two systematic searches were conducted using seven databases (MEDLINE, Embase, PsychInfo, CINAHL Plus, AMED, PubMed and Web of Science) with combined variations of the terms "Management", "Guidelines", "Chronic Low Back Pain", "Beliefs", "Patients", "Healthcare Professionals" and "Africa". RESULTS Five studies and one standard treatment guideline document were included. No systematically developed African CLBP treatment guideline was found, although CLBP practices were identified in two African countries. CLBP management in African countries appears to be biomedically orientated. Only three research articles investigated the CLBP beliefs of patients in Africa, with none assessing HCP beliefs. Unhelpful CLBP beliefs (catastrophizing and fear avoidance) and biomedical thoughts about the causes of CLBP were identified. Unhelpful CLBP beliefs were associated with increased disability. CONCLUSIONS Management practices for CLBP in African countries appear to contradict recommended biopsychosocial management guidelines by developed countries and are not sufficiently documented. Research on CLBP beliefs and CLBP management practices in Africa is lacking. To enhance the uptake of biopsychosocial approach in Africa, research around CLBP beliefs in African CLBP patients and HCPs is required.
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Affiliation(s)
- Josephine Ahenkorah
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire Diver
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paapa Kwesi Ampiah
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
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168
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Multiple diagnoses, increased kinesiophobia? - Patients with high kinesiophobia levels showed a greater number of temporomandibular disorder diagnoses. Musculoskelet Sci Pract 2019; 44:102054. [PMID: 31491618 DOI: 10.1016/j.msksp.2019.102054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/07/2019] [Accepted: 08/29/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of this study was to empirically derive subgroups according to pain-related fear of movement beliefs using cluster analysis within a sample of TMD patients and asymptomatic volunteers. METHODS 129 volunteers participated in this cross-sectional study (34.78, standard deviation [SD]: 12.49 years; 92 TMD patients and 37 symptom-free volunteers). Mechanical pain sensitivity through pressure pain threshold (PPT) on orofacial and remote sites, kinesiophobia, pain catastrophizing, anxiety and depression were assessed. A cluster analysis was used to derive subgroups according to kinesiophobia scores (TSK/TMD). RESULTS Three subgroups were derived: cluster 1 (high kinesiophobia [n = 53], TSK score: 33, SD[standard deviation] = 2.9), cluster 2 (moderate kinesiophobia [n = 50], TSK score: 26.2, SD = 2.14) and cluster 3 (no/low kinesiophobia [n = 26], TSK score 12.12, SD = 2.08) which included patients with higher overall PPT and lower scores on psychosocial variables. The group with high kinesiophobia showed high levels of pain catastrophizing, anxiety, and orofacial pain-related disability compared to the other subgroups and mechanical pain hyperalgesia in remote site compared to the low-kinesiophobia group. Also, we found a greater prevalence of triple diagnosis for the high-kinesiophobia subgroup compared to the moderate kinesiophobia group - odds ratio: 12.6 (95% confidence interval [CI]: 3.31-43.52, p < 0.01). CONCLUSION These results suggested that patients with TMD and higher levels of kinesiophobia beliefs may show a more complex clinical feature, with high psychosocial distress, widespread mechanical pain sensitivity, and a more complex TMD disorder. In this way, we suggest a relationship between the number of TMD diagnoses and kinesiophobia severity.
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169
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Fujii T, Oka H, Takano K, Asada F, Nomura T, Kawamata K, Okazaki H, Tanaka S, Matsudaira K. Association between high fear-avoidance beliefs about physical activity and chronic disabling low back pain in nurses in Japan. BMC Musculoskelet Disord 2019; 20:572. [PMID: 31779617 PMCID: PMC6883590 DOI: 10.1186/s12891-019-2965-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/22/2019] [Indexed: 11/22/2022] Open
Abstract
Background High prevalence of low back pain (LBP) in nurses has been reported globally. Ergonomic factors and work-related psychosocial factors have been focused on as risk factors. However, evidence on the role of fear-avoidance beliefs (FABs) concerning LBP in nurses is lacking. This study examined LBP prevalence and the association between FABs and chronic disabling LBP that interfered with work and lasted ≥ 3 months. Methods Female nurses (N = 3066; mean age = 35.8 ± 10.6 years) from 12 hospitals in Japan participated. A self-reported questionnaire was used to collect information on sociodemographics, LBP, work-related factors, and psychological distress. FABs about physical activity were assessed using a subscale from the FAB Questionnaire (score range = 0–24). The participants were asked to choose one of four statements regarding their LBP in the past 4 weeks: 1) I did not have LBP, 2) I had LBP without work difficulty, 3) I had LBP with work difficulty but without requiring absence from work, and 4) I had LBP requiring absence from work. If the participant had LBP in the past 4 weeks, it was also inquired if the LBP had lasted for ≥ 3 months. Chronic disabling LBP was defined as experiencing LBP with work difficulty in the past 4 weeks which had lasted for ≥ 3 months. In the nurses who had experienced any LBP in the past 4 weeks, we examined the association between FABs and experiencing chronic disabling LBP using multiple logistic regression models adjusting for pain intensity, age, body mass index, smoking status, psychological distress, hospital department, weekly work hours, night shift work, and the12 hospitals where the participants worked. Results Four-week and one-year LBP prevalence were 58.7 and 75.9%, respectively. High FABs (≥ 15) were associated with chronic disabling LBP (adjusted odds ratio = 1.76, 95% confidence interval [1.21–2.57], p = 0.003). Conclusions LBP is common among nurses in Japan. FABs about physical activity might be a potential target for LBP management in nurses. Trial registration UMIN-CTR UMIN000018087. Registered: June 25, 2015.
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Affiliation(s)
- Tomoko Fujii
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kenichiro Takano
- Research Center for the Health Promotion and Employment Support, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Fuminari Asada
- Research Center for the Health Promotion and Employment Support, Osaka Rosai Hospital, Osaka, Japan
| | - Takuo Nomura
- Department of Rehabilitation Sciences, Kansai University of Welfare Sciences, Osaka, Japan
| | - Kayo Kawamata
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Okazaki
- Department of Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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170
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Tagliaferri SD, Miller CT, Owen PJ, Mitchell UH, Brisby H, Fitzgibbon B, Masse-Alarie H, Van Oosterwijck J, Belavy DL. Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective. Pain Pract 2019; 20:211-225. [PMID: 31610090 DOI: 10.1111/papr.12846] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 12/25/2022]
Abstract
Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment; however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear-avoidance, pain catastrophizing, pain self-efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health-related quality-of-life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered "real" in an individual patient. This information can guide treatment selection when working with an individual with CLBP.
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Affiliation(s)
- Scott D Tagliaferri
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Clint T Miller
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Patrick J Owen
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, U.S.A
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Bernadette Fitzgibbon
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Hugo Masse-Alarie
- Centre Interdisciplinaire de Recherche en Réadaptation et Integration Sociale (CIRRIS), Université Laval, Québec City, Québec, Canada
| | - Jessica Van Oosterwijck
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium.,Pain in Motion International Research Group
| | - Daniel L Belavy
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
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171
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Hamasaki T, Pelletier R, Bourbonnais D, Harris P, Choinière M. Pain-related psychological issues in hand therapy. J Hand Ther 2019; 31:215-226. [PMID: 29449064 DOI: 10.1016/j.jht.2017.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/16/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Literature review. INTRODUCTION Pain is a subjective experience that results from the modulation of nociception conveyed to the brain via the nervous system. Perception of pain takes place when potential or actual noxious stimuli are appraised as threats of injury. This appraisal is influenced by one's cognitions and emotions based on her/his pain-related experiences, which are processed in the forebrain and limbic areas of the brain. Unarguably, patients' psychological factors such as cognitions (eg, pain catastrophizing), emotions (eg, depression), and pain-related behaviors (eg, avoidance) can influence perceived pain intensity, disability, and treatment outcomes. Therefore, hand therapists should address the patient pain experience using a biopsychosocial approach. However, in hand therapy, a biomedical perspective predominates in pain management by focusing solely on tissue healing. PURPOSE OF THE STUDY This review aims to raise awareness among hand therapists of the impact of pain-related psychological factors. METHODS AND RESULTS This literature review allowed to describe (1) how the neurophysiological mechanisms of pain can be influenced by various psychological factors, (2) several evidence-based interventions that can be integrated into hand therapy to address these psychological issues, and (3) some approaches of psychotherapy for patients with maladaptive pain experiences. DISCUSSION AND CONCLUSION Restoration of sensory and motor functions as well as alleviating pain is at the core of hand therapy. Numerous psychological factors including patients' beliefs, cognitions, and emotions alter their pain experience and may impact on their outcomes. Decoding the biopsychosocial components of the patients' pain is thus essential for hand therapists.
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Affiliation(s)
- Tokiko Hamasaki
- Research Center of the CHUM, Montreal, Québec, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Hand Center, CHUM, Montreal, Québec, Canada
| | - René Pelletier
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Daniel Bourbonnais
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Québec, Canada
| | - Patrick Harris
- Hand Center, CHUM, Montreal, Québec, Canada; Department of Surgery, Plastic Surgery Service, CHUM, Montreal, Québec, Canada; Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Manon Choinière
- Research Center of the CHUM, Montreal, Québec, Canada; Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada.
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172
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Wong JJ, Tricco AC, Côté P, Rosella LC. The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review. Syst Rev 2019; 8:267. [PMID: 31703727 PMCID: PMC6839250 DOI: 10.1186/s13643-019-1192-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 10/09/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND A considerable proportion of adults with low back pain (LBP) suffer from depressive symptoms or depression. Those with depressive symptoms or depression may be at risk of poorer LBP recovery and require more health care. Understanding the role of prognostic factors for LBP is critically important to guide management and health services delivery. Our objective is to conduct a systematic review to assess the association between depressive symptoms or depression and health outcomes in adults with LBP with or without radiculopathy. METHODS Electronic databases including MEDLINE, Embase, CINAHL, and PsycINFO will be searched from inception to April 2019 to identify relevant studies. Additional citations will be identified by searching reference lists of included studies and related systematic reviews. Cohort and case-control studies assessing the association between depressive symptoms/depression and health outcomes in adults aged 16 years and older with LBP with or without radiculopathy will be included. The following will be included: depressive symptoms as measured on standardized questionnaires (e.g., Center for Epidemiologic Studies Depression Scale, Beck Depression Index), and depression as standardized diagnoses (e.g., International Classification of Diseases codes) or self-reported depression diagnosis on standardized questionnaires. Outcomes of interest are standardized measures for pain, disability, overall health status, satisfaction with care, and health care utilization. These are informed by core outcome domains that international expert panels consider important for LBP research. Pairs of reviewers will screen articles retrieved from the search, extract data, and assess risk of bias using the Risk Of Bias In Non-randomized Studies-of Exposures (ROBINS-E) tool. Reviewers will use these criteria to inform their judgment on the internal validity of studies (e.g., low, moderate, or high risk of bias). If studies are deemed homogeneous, a random effects meta-analysis on the association between depressive symptoms and health outcomes will be performed. The results of the included studies will be descriptively outlined if studies are deemed heterogeneous. DISCUSSION The impact of depressive symptoms and depression on health- and health care-related outcomes for LBP with or without radiculopathy will be assessed and quantified. Findings of this systematic review will advance our understanding of LBP prognosis, and guide decision-making and improve quality of care for adults with LBP. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019130047.
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Affiliation(s)
- Jessica J. Wong
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, ON L1H 7K4 Canada
| | - Andrea C. Tricco
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Knowledge Translation Program, 209 Victoria Street, East Building, Room 716, Toronto, ON M5B 1W8 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, ON M5T 3M7 Canada
| | - Pierre Côté
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, ON L1H 7K4 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, ON M5T 3M7 Canada
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1H 7K4 Canada
| | - Laura C. Rosella
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
- ICES, 155 College Street, Toronto, ON M5T 3M7 Canada
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O'Keeffe M, O'Sullivan P, Purtill H, Bargary N, O'Sullivan K. Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT). Br J Sports Med 2019; 54:782-789. [PMID: 31630089 PMCID: PMC7361017 DOI: 10.1136/bjsports-2019-100780] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 12/29/2022]
Abstract
Background One-size-fits-all interventions reduce chronic low back pain (CLBP) a small amount. An individualised intervention called cognitive functional therapy (CFT) was superior for CLBP compared with manual therapy and exercise in one randomised controlled trial (RCT). However, systematic reviews show group interventions are as effective as one-to-one interventions for musculoskeletal pain. This RCT investigated whether a physiotherapist-delivered individualised intervention (CFT) was more effective than physiotherapist-delivered group-based exercise and education for individuals with CLBP. Methods 206 adults with CLBP were randomised to either CFT (n=106) or group-based exercise and education (n=100). The length of the CFT intervention varied according to the clinical progression of participants (mean=5 treatments). The group intervention consisted of up to 6 classes (mean=4 classes) over 6–8 weeks. Primary outcomes were disability and pain intensity in the past week at 6 months and 12months postrandomisation. Analysis was by intention-to-treat using linear mixed models. Results CFT reduced disability more than the group intervention at 6 months (mean difference, 8.65; 95% CI 3.66 to 13.64; p=0.001), and at 12 months (mean difference, 7.02; 95% CI 2.24 to 11.80; p=0.004). There were no between-group differences observed in pain intensity at 6 months (mean difference, 0.76; 95% CI -0.02 to 1.54; p=0.056) or 12 months (mean difference, 0.65; 95% CI -0.20 to 1.50; p=0.134). Conclusion CFT reduced disability, but not pain, at 6 and 12 months compared with the group-based exercise and education intervention. Future research should examine whether the greater reduction in disability achieved by CFT renders worthwhile differences for health systems and patients. Trial registration number ClinicalTrials.gov registry (NCT02145728).
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Affiliation(s)
- Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Shenton Park, Perth, Western Australia, Australia.,Bodylogic Physiotherapy, Perth, Western Australia, Australia
| | - Helen Purtill
- Department of Mathematics & Statistics, Faculty of Science & Engineering, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Aging Research Centre, University of Limerick, Limerick, Ireland
| | - Norma Bargary
- Department of Mathematics & Statistics, Faculty of Science & Engineering, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kieran O'Sullivan
- Health Research Institute, University of Limerick, Limerick, Ireland.,Aging Research Centre, University of Limerick, Limerick, Ireland.,Sports Spine Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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Burgess R, Mansell G, Bishop A, Lewis M, Hill J. Predictors of functional outcome in musculoskeletal healthcare: An umbrella review. Eur J Pain 2019; 24:51-70. [DOI: 10.1002/ejp.1483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Roanna Burgess
- Primary Care Centre Versus Arthritis Research Institute for Primary Care & Health Sciences Keele University Keele Staffordshire UK
- Sandwell and West Birmingham Hospitals NHS Trust Birmingham City Hospital Birmingham UK
| | - Gemma Mansell
- Primary Care Centre Versus Arthritis Research Institute for Primary Care & Health Sciences Keele University Keele Staffordshire UK
| | - Annette Bishop
- Primary Care Centre Versus Arthritis Research Institute for Primary Care & Health Sciences Keele University Keele Staffordshire UK
| | - Martyn Lewis
- Primary Care Centre Versus Arthritis Research Institute for Primary Care & Health Sciences Keele University Keele Staffordshire UK
| | - Jonathan Hill
- Primary Care Centre Versus Arthritis Research Institute for Primary Care & Health Sciences Keele University Keele Staffordshire UK
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175
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Multivariate Analysis of Risk Factors Predisposing to Kinesiophobia in Persons With Chronic Low Back and Neck Pain. J Manipulative Physiol Ther 2019; 42:565-571. [DOI: 10.1016/j.jmpt.2019.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 02/12/2019] [Accepted: 02/20/2019] [Indexed: 11/20/2022]
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176
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Yoshimoto T, Oka H, Ishikawa S, Kokaze A, Muranaga S, Matsudaira K. Factors associated with disabling low back pain among nursing personnel at a medical centre in Japan: a comparative cross-sectional survey. BMJ Open 2019; 9:e032297. [PMID: 31562162 PMCID: PMC6773308 DOI: 10.1136/bmjopen-2019-032297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Low back pain (LBP) is a common cause of disability among nursing personnel. Although many studies regarding the risk factors for LBP among nursing staff have focused on the physical load at work, multidimensional assessments of risk factors are essential to identify appropriate preventive strategies. We aimed to investigate the association of multidimensional factors (individual, physical, psychological and occupational) with disabling LBP among nursing personnel in Japan. DESIGN Observational study with comparative cross-sectional design. SETTING Data were collected using the self-administered questionnaire at a tertiary medical centre. PARTICIPANTS After excluding participants with missing variables, 718 nursing personnel were included in the analysis. OUTCOME MEASURES A self-administered questionnaire assessed individual characteristics, rotating night shift data, severity of LBP, previous episode of LBP, sleep problem, kinesiophobia (Tampa Scale for Kinesiophobia), depressive condition (K6), physical flexibility and frequency of lifting at work. A logistic regression model was used to evaluate the factors associated with disabling LBP (LBP interfering with work) among nursing personnel. RESULTS Of all participants, 110 (15.3%) reported having disabling LBP. The multivariable logistic regression analysis after adjustment for several confounding factors showed that kinesiophobia (highest tertile, adjusted OR (aOR): 6.13, 95% CI : 3.34 to 11.27), previous episode of LBP (aOR: 4.31, 95% CI: 1.50 to 12.41) and insomnia (aOR: 1.66, 95% CI: 1.05 to 2.62) were significantly associated with disabling LBP. CONCLUSIONS The present study indicated that kinesiophobia, a previous episode of LBP, and sleep problems were associated with disabling LBP among nursing personnel. In the future, workplace interventions considering assessments of these factors may reduce the incidence of disabling LBP in nursing staff, although further prospective studies are needed.
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Affiliation(s)
- Takahiko Yoshimoto
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Shinagawa-ku, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, The University of Tokyo, Bunkyo-ku, Japan
| | - Shuhei Ishikawa
- Department of Rehabilitation, Kameda Medical Centre, Kamogawa, Japan
| | - Akatsuki Kokaze
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Shinagawa-ku, Japan
| | - Shingo Muranaga
- Department of Rehabilitation, Kameda Medical Centre, Kamogawa, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, The University of Tokyo, Bunkyo-ku, Japan
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177
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Wong JJ, Côté P, Tricco AC, Rosella LC. Examining the effects of low back pain and mental health symptoms on healthcare utilisation and costs: a protocol for a population-based cohort study. BMJ Open 2019; 9:e031749. [PMID: 31562160 PMCID: PMC6773279 DOI: 10.1136/bmjopen-2019-031749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Low back pain (LBP) is a leading cause of disability associated with high healthcare utilisation and costs. Mental health symptoms are negative prognostic factors for LBP recovery; however, no population-based studies have assessed the joint effects of LBP and mental health symptoms on healthcare utilisation. This proposed study will characterise the health system burden of LBP and help identify priority groups to inform resource allocation and public health strategies. Among community-dwelling adult respondents of five cycles of the Canadian Community Health Survey (CCHS) in Ontario, we aim to assess the effect of self-reported LBP on healthcare utilisation and costs and assess whether this effect differs between those with and without self-reported mental health symptoms. METHODS AND ANALYSIS We designed a dynamic population-based cohort study using linkages of survey and administrative data housed at ICES. The Ontario sample of CCHS (2003-2004, 2005-2006, 2007/2008, 2009/2010, 2011/2012; total of ~1 30 000 eligible respondents) will be used to define the cohort of adults with self-reported LBP with and without mental health symptoms. Healthcare utilisation and costs will be assessed by linking health administrative databases. Follow-up ranges from 6 to 15 years (until 31 March 2018). Sociodemographic (eg, age, sex, education) and health behaviour (eg, comorbidities, physical activity) factors will be considered as potential confounders. Poisson and linear (log-transformed) regression models will be used to assess the association between LBP and healthcare utilisation and costs. We will assess effect modification with mental health symptoms on the additive and multiplicative scales and conduct sensitivity analyses to assess the impact of misclassification and residual confounding. ETHICS AND DISSEMINATION This study is approved by the University of Toronto Research Ethics Board. We will disseminate findings using a multifaceted knowledge translation strategy, including scientific conference presentations, publications in peer-reviewed journals and workshops with key knowledge users.
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Affiliation(s)
- Jessica J Wong
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Oshawa, Ontario, Canada
| | - Pierre Côté
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Oshawa, Ontario, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Laura C Rosella
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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178
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Ushio M, Sumitani M, Abe H, Mietani K, Hozumi J, Inoue R, Tsuchida R, Ushida T, Yamada Y. Characteristics of Locomotive Syndrome in Japanese Patients with Chronic Pain and Results of a Path Analysis Confirming the Relevance of a Vicious Cycle Involving Locomotive Syndrome, Musculoskeletal Pain, and Its Psychological Factors. JMA J 2019; 2:184-189. [PMID: 33615029 PMCID: PMC7889790 DOI: 10.31662/jmaj.2019-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/18/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction: The current aging population has a major impact on public health. Locomotive syndrome (LS) is a condition that carries a high risk for developing systemic musculoskeletal disability. Methods: Participants were patients with chronic pain (n = 415) who were examined at the Japanese multidisciplinary pain centers of the research consortium. They completed the 25-question geriatric locomotive function scale (GLFS-25; LS screening tool), an 11-point numerical rating scale (NRS) of pain intensity and its psychological distresses, health-related quality of life (HRQOL) questionnaire, and a survey of exercise habits. A multifaceted analysis of the relevance of the pain, psychological distresses, and LS were conducted using SPSS and AMOS software. Results: 337 patients (81.2%) were found to have LS. The final model of a multifaceted analysis demonstrated good fitness for the “vicious cycle” model among the results of LS, pain intensity, impairment of self-efficacy, and depression; these parameters independently impaired HRQOL. Anxiety related to falling (GLFS-25) and exercise habits affected the model. Conclusions: These findings indicate LS, LS-related pain, and psychological distress create a vicious cycle, resulting in the impairment of HRQOL. Treatment strategies for LS should inclusively focus on musculoskeletal disorders, pain, and pain-related psychological factors.
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Affiliation(s)
- Michiko Ushio
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroaki Abe
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazuhito Mietani
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Jun Hozumi
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Reo Inoue
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Rikuhei Tsuchida
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Takahiro Ushida
- Multidisciplinary Pain Center, School of Medicine, Aichi Medical University, Aichi, Japan
| | - Yoshitsugu Yamada
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
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179
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Storm V. [Fear avoidance beliefs, pain-related self-efficacy, and subjective work ability among back pain patients : A pilot study with voluntary subjects]. Schmerz 2019; 33:312-319. [PMID: 31041528 DOI: 10.1007/s00482-019-0371-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Work-related fear avoidance beliefs play an important role when considering subjective work ability among people with back pain. Pain-related self-efficacy is known as a predictor for physical activity and subjective work ability. OBJECTIVES The present longitudinal study aims to investigate the relationships between work-related fear avoidance beliefs, pain-related self-efficacy, and subjective work ability among back pain patients. MATERIALS AND METHODS A total of 93 people with back pain (M = 35.58 years, SD = 13.45; range: 18-69) were assessed at baseline and 4 weeks later. Of the participants, 54.83% (n = 51) were female. Data analysis was performed with SPSS 25 using descriptive statistics and multiple regression methods. RESULTS Work-related fear avoidance beliefs were negatively related with subjective work ability at baseline. Pain-related self-efficacy moderated this relationship. The relationship was stronger at low and medium levels of pain-related self-efficacy. The moderation effect was not found when considering subjective work ability after 4 weeks. CONCLUSION Work-related fear avoidance beliefs among back pain patients seem to be important for subjective work ability in the short term. This especially holds true when patients have low self-efficacy beliefs. The investigated constructs should be emphasized in the patient-centered therapy. Longitudinal studies with larger samples and more frequent follow-ups should be investigated in future studies.
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Affiliation(s)
- Vera Storm
- Institut für Sportwissenschaften, Abteilung Sportpsychologie, Universität Münster, Horstmarer Landweg 62b, 48149, Münster, Deutschland.
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180
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Health-related Quality of Life and Postural Changes of Spinal Alignment in Female Adolescents Associated With Back Pain in Adolescent Idiopathic Scoliosis: A Prospective Cross-sectional Study. Spine (Phila Pa 1976) 2019; 44:E833-E840. [PMID: 30817729 DOI: 10.1097/brs.0000000000002996] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cross-sectional study. OBJECTIVE To identify risk factors for chronic back pain and back pain at rest in adolescent idiopathic scoliosis (AIS) patients, particularly focusing on the psychological backgrounds of the patients and on postural changes of radiographical parameters for spinal alignment. SUMMARY OF BACKGROUND DATA Back pain has been recognized as a relatively common condition in AIS. However, the effect of patients' psychological backgrounds and dynamic changes of spinal alignment on back pain are unclear. METHODS One hundred two consecutive female AIS patients (mean age, 14.1 yrs [range, 10-18]) who first visited our outpatient clinic between July 2013 and December 2017 were included. Using SRS-22r questionnaire, the presence of chronic back pain and back pain at rest and the scores of self-image and mental health were evaluated. Using full-length standing and supine posteroanterior radiographs, parameters related to curve profiles and coronal global balance were measured, and postural changes of these parameters were calculated. From full-length standing lateral radiographs, sagittal spinal and spino-pelvic alignment parameters were also measured. Multivariate logistic regression analysis was performed to identify risk factors for back pain. RESULTS The prevalence of chronic back pain was 22.5% and that of back pain at rest was 25.5%. Poor self-image and mental health scores in SRS-22r were identified as risk factors for chronic back pain. Higher Risser grade, poor self-image score, large postural changes of apical vertebral translation at the main thoracic curve, and hyperlordosis in the lumbar spine were identified as risk factors for back pain at rest. CONCLUSION Psychological distress and large postural changes of spinal alignment played an important role in the occurrence of back pain. Physicians should pay more attention to mental healthcare of AIS patients as well as to radiographical assessments of curve severity for better health-related quality of life. LEVEL OF EVIDENCE 4.
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181
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Hirayama K, Tsushima E, Arihara H, Omi Y. Developing a clinical prediction rule to identify patients with lumbar disc herniation who demonstrate short-term improvement with mechanical lumbar traction. Phys Ther Res 2019; 22:9-16. [PMID: 31289707 DOI: 10.1298/ptr.e9973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/07/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To develop a clinical prediction rule (CPR) that predicts treatment responses to mechanical lumbar traction (MLT) among patients with lumbar disc herniation (LDH). METHOD This study was an uncontrolled prospective cohort study. The subjects included 103 patients diagnosed with LDH for which they underwent conservative therapy. The subjects received MLT for 2 weeks, and the application of any other medication was left at the discretion of the attending physician. The initial evaluation was performed prior to the initiation of treatment. The independent variables from the initial evaluation were imaging diagnosis, Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire score, visual analog scale, medical interview, physical examination. The patients whose ODI after 2 weeks of treatment improved by ≥50% of that at the initial evaluation were defined as responders. RESULTS Of the 103 subjects, 24 were responders, and the five predictors selected for the CPR were limited lumbar extension range of motion, low-level fear-avoidance beliefs regarding work, no segmental hypomobility in the lumbar spine, short duration of symptoms, and sudden onset of symptoms. For the patients with at least three of the five predictors, the probability of their ODI greatly improving increased from 23.3% to 48.7% compared with the patients without these predictors (positive likelihood ratio, 3.13). CONCLUSION Five factors were selected for the CPR to predict whether patients with LDH would demonstrate short-term improvement following conservative therapy with MLT.
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Affiliation(s)
- Kazuya Hirayama
- Department of Rehabilitation, Omi Orthopedic Clinic.,Graduate School of Health Sciences, Hirosaki University
| | - Eiki Tsushima
- Graduate School of Health Sciences, Hirosaki University
| | | | - Yoichi Omi
- Department of Orthopedic Surgery, Omi Orthopedic Clinic
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182
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Verwoerd M, Wittink H, Maissan F, de Raaij E, Smeets RJEM. Prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: A systematic review. Musculoskelet Sci Pract 2019; 42:13-37. [PMID: 31026716 DOI: 10.1016/j.msksp.2019.03.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 01/29/2019] [Accepted: 03/22/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prognosis of acute idiopathic neck pain is poor. An overview of modifiable and non-modifiable prognostic factors for the development of chronic musculoskeletal neck pain after an episode of idiopathic, non-traumatic neck pain is needed. OBJECTIVE Identify prognostic factors for pain intensity and perceived non-recovery at three, six and 12 months after a first episode of idiopathic, non-traumatic neck pain. STUDY DESIGN Systematic review METHODS: Systematic literature search up to October 21, 2017 for prospective prognostic studies with main outcomes perceived non-recovery and pain intensity. The QUIPS was used for quality assessment. RESULTS Out of 2737 screened articles six prospective studies with high-risk-of-bias were identified, analyzing 47 and 43 factors for the outcome variables 'pain intensity' and 'perceived non-recovery', respectively. Based on univariate- and multivariate analyses we found moderate evidence for 'age> 40 years' and 'concomitant back pain' to be prognostic for 'pain intensity'. For the outcome 'perceived non-recovery' at 12 months, we found moderate evidence for both 'a previous period of neck pain' and 'accompanying headache' as prognostic variables for persistent pain, based on univariate analysis. No prognostic factor was found which was retained in more than one multivariate analysis for the outcome variable 'perceived non-recovery'. However, the quality of the evidence for these prognostic factors was low to very low. CONCLUSION This review identifies prognostic factors for neck pain, of which only a few are modifiable. Further research is needed before drawing definite conclusions about the prognostic value of these factors.
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Affiliation(s)
- Martine Verwoerd
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Heidelberglaan 7, Utrecht, the Netherlands.
| | - Harriet Wittink
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Heidelberglaan 7, Utrecht, the Netherlands
| | - Francois Maissan
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Heidelberglaan 7, Utrecht, the Netherlands
| | - Edwin de Raaij
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Heidelberglaan 7, Utrecht, the Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University; CIR Rehabilitation, Eindhoven, The Netherlands
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183
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Leahy A, O’Keeffe M, Robinson K, O’Sullivan K. The beliefs of healthcare students about the harmfulness of daily activities for their back: a cross-sectional study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1630854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Aoife Leahy
- Barking Havering and Redbridge University Trust, Romford, England
| | - Mary O’Keeffe
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, Sydney, Australia
| | - Katie Robinson
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kieran O’Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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184
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Gajsar H, Titze C, Levenig C, Kellmann M, Heidari J, Kleinert J, Rusu AC, Hasenbring MI. Psychological pain responses in athletes and non-athletes with low back pain: Avoidance and endurance matter. Eur J Pain 2019; 23:1649-1662. [PMID: 31220382 DOI: 10.1002/ejp.1442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/26/2019] [Accepted: 06/16/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Dysfunctional psychological pain responses, namely fear-avoidance (FAR), including catastrophizing and helplessness, as well as endurance-related responses (ER), including thought suppression and overactivity, have been shown to be risk factors for persistent low back pain (LBP). Literature suggests that athletes may differ from non-athletes regarding psychological responses to pain. OBJECTIVES This study set out to compare FAR and ER between athletes and non-athletes with LBP. It was hypothesized that athletes would report less frequent FAR and more frequent ER, and that both FAR and ER are associated with LBP intensity and disability. METHODS The 173 athletes and 93 non-athletes cross-sectionally reported how frequently they employ FAR and ER on the Avoidance-Endurance Questionnaire (AEQ), as well as LBP intensity and disability on the Chronic Pain Grade Questionnaire (CPGS). MANOVA was applied to compare FAR and ER between athletes and non-athletes. Hierarchical multiple linear regression models were used to determine the unique associations between FAR and ER with LBP intensity and disability. RESULTS Athletes reported lower frequencies of behavioural avoidance than non-athletes, but no other FAR variables differed between the groups. Frequencies of ER did not differ between athletes and non-athletes. Regression analysis indicated substantial associations of FAR with LBP intensity, as well as of FAR and ER with disability in athletes and non-athletes. CONCLUSIONS The results of the present study suggest that athletes and non-athletes with LBP differ regarding behavioural avoidance, but overall, differences regarding pain responses are marginal. FAR and ER are both reported in athletes and non-athletes and contribute to disability in both groups. SIGNIFICANCE Athletes train to endure pain in the course of athletic socialization, at least in the context of exercise. However, there is sparsity of knowledge about psychological pain responses in athletes with low back pain and whether they differ from those in non-athletes. The results of this comparative study suggest that endurance responses are more frequent than avoidance responses among athletes and non-athletes alike. However, both types of responses seem relevant to clinical pain management in athletes as well as non-athletes.
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Affiliation(s)
- Hannah Gajsar
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany
| | - Christina Titze
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany
| | - Claudia Levenig
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany
| | - Michael Kellmann
- Unit of Sport Psychology, Ruhr University of Bochum, Bochum, Germany.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Jahan Heidari
- Unit of Sport Psychology, Ruhr University of Bochum, Bochum, Germany
| | - Jens Kleinert
- Department of Health and Social Psychology, German Sport University Cologne, Cologne, Germany
| | - Adina Carmen Rusu
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany
| | - Monika Ilona Hasenbring
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr University of Bochum, Bochum, Germany.,Faculty of Health Science, Southern University of Denmark, Odense, Denmark
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185
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Luque-Suarez A, Falla D, Morales-Asencio JM, Martinez-Calderon J. Is kinesiophobia and pain catastrophising at baseline associated with chronic pain and disability in whiplash-associated disorders? A systematic review. Br J Sports Med 2019; 54:892-897. [PMID: 31217158 DOI: 10.1136/bjsports-2018-099569] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Kinesiophobia and pain catastrophising may be associated with patients' transition from having acute to chronic pain following a whiplash injury. OBJECTIVE To systematically review and critically appraise the literature to determine whether kinesiophobia and pain catastrophising are associated with greater likelihood of patients developing chronic pain and disability following a whiplash injury. DESIGN A systematic review of the literature DATA SOURCES: Electronic searches of PubMed, AMED, CINAHL, PsycINFO, and PubPsych, and grey literature were undertaken from inception to September 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Study selection was based on longitudinal studies evaluating how kinesiophobia and/or pain catastrophising at baseline are associated with pain intensity, disability or both after a whiplash injury. RESULTS We included 14 longitudinal studies that described 12 independent cohorts with a total sample of 2733 participants with whiplash-associated disorder. Kinesiophobia at baseline was not associated with pain intensity over time (three studies). Whether kinesiophobia at baseline was associated with disability was unclear as results were conflicting (six studies). There were also conflicting results when we examined the association between pain catastrophising and both pain intensity (five studies) and disability (eight studies). SUMMARY/CONCLUSIONS Kinesiophobia at baseline was not associated with pain intensity over time. There were conflicting results for the remaining analyses. The size of the associations was small. The overall quality of the evidence was very low. TRIAL REGISTRATION NUMBER CRD42016053864.
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Affiliation(s)
- Alejandro Luque-Suarez
- Faculty of Health Sciences, Department of Physiotherapy, University of Malaga, Malaga, Spain .,Instituto de Investigacion Biomedica de Malaga (IBIMA), Malaga, Spain
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jose Miguel Morales-Asencio
- Instituto de Investigacion Biomedica de Malaga (IBIMA), Malaga, Spain.,Faculty of Health Sciences, Department of Physiotherapy, University of Malaga, Malaga, Spains
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186
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Longitudinal associations of kinematics and fear-avoidance beliefs with disability, work ability and pain intensity in persons with low back pain. Musculoskelet Sci Pract 2019; 41:49-54. [PMID: 30939423 DOI: 10.1016/j.msksp.2019.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Impaired lumbar movement has cross-sectionally been associated with low back pain (LBP); however, the consequence of impaired movement on disability and pain in persons with LBP is poorly understood. Furthermore, fear-avoidance beliefs (FAB) may influence spinal movement, but the relation between fear-avoidance and kinematics is unclear. OBJECTIVES To investigate the longitudinal associations of kinematics and FAB with disability, work ability and pain in patients with LBP. Further, to explore associations between FAB and kinematics. DESIGN Prospective observational study. METHOD Kinematic measures were performed on 44 persons with LBP at baseline, three and nine months. Motion sensors identified range-of-motion and velocity during a spinal flexion/extension. FAB, disability, work ability and pain were reported at all time points using questionnaires. RESULTS Increased range-of-motion was weakly associated with less disability (-0.14 points, 95% CI -0.22 to -0.06). Velocity was not associated with disability, work ability or pain. Higher FAB of physical activity were associated with more disability (1.50 points, 95% CI 0.51 to 2.49) and pain (0.37 points, 95% CI 0.11 to 0.62). Higher work-related FAB was associated with lower work ability (-0.37 points, 95% CI -0.68 to -0.05). Moreover, higher FAB showed weak associations with lower velocity in the initial movement phase (-3.3°/s, 95% CI -6.1 to -0.5). CONCLUSIONS Of the kinematic measures, only range-of-motion was related to disability. Higher FAB was weakly associated with all self-reported outcomes and with lower velocity only at the initial flexion phase. However, the magnitude of these associations suggest marginal clinical importance.
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Nicholas MK, Costa DSJ, Linton SJ, Main CJ, Shaw WS, Pearce R, Gleeson M, Pinto RZ, Blyth FM, McCauley JH, Maher CG, Smeets RJEM, McGarity A. Predicting Return to Work in a Heterogeneous Sample of Recently Injured Workers Using the Brief ÖMPSQ-SF. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:295-302. [PMID: 29796980 DOI: 10.1007/s10926-018-9784-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose (1) to examine the ability of the Örebro Musculoskeletal Pain Screening Questionnaire-short version (ÖMPSQ-SF) to predict time to return to pre-injury work duties (PID) following a work-related soft tissue injury (regardless of body location); and (2) to examine the appropriateness of 50/100 as a suitable cut-off score for case identification. Methods Injured workers (IW) from six public hospitals in Sydney, Australia, who had taken medically-sanctioned time off work due to their injury, were recruited by insurance case managers within 5-15 days of their injury. Eligible participants (N = 213 in total) were administered the ÖMPSQ-SF over the telephone by the case manager. For objective (1) Cox proportional hazards regression analysis was used to predict days to return to PID using the ÖMPSQ-SF. For objective (2) receiver operator characteristic (ROC) analysis was used to determine the ÖMPSQ-SF total score that optimises sensitivity and specificity in detecting whether or not participants had returned to PID within 2-7 weeks. Results The total ÖMPSQ-SF score significantly predicted number of days to return to PID, such that for every 1-point increase in the total ÖMPSQ-SF score the predicted chance of returning to work reduced by 4% (i.e., hazard ratio = 0.96), p < 0.001. Sensitivity and specificity for the ROC analysis comparing ÖMPSQ-SF total score to return to PID within 2-7 weeks suggested 48 as the optimal cut off (sensitivity = 0.65, specificity = 0.79). Conclusion The results provide strong support for the use of the ÖMPSQ-SF in an applied setting for identifying those IW likely to have delayed RTW when administered within 15 days of the injury. While a score of 48/100 was the optimal cut point for sensitivity and specificity, pragmatically, 50/100 should be acceptable as a cut-off in future studies of this type.
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Affiliation(s)
- M K Nicholas
- Sydney Medical School - Northern, University of Sydney & Royal North Shore Hospital, St Leonards, NSW, Australia.
| | - D S J Costa
- Sydney Medical School - Northern, University of Sydney & Royal North Shore Hospital, St Leonards, NSW, Australia
| | - S J Linton
- Department of Law, Psychology, and Social Work, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - C J Main
- Arthritis Care UK Primary Care Centre, Keele University, North Staffordshire, UK
| | - W S Shaw
- University of Connecticut Health Center, Farmington, CT, USA
| | - R Pearce
- Sydney Medical School - Northern, University of Sydney & Royal North Shore Hospital, St Leonards, NSW, Australia
| | - M Gleeson
- Sydney Medical School - Northern, University of Sydney & Royal North Shore Hospital, St Leonards, NSW, Australia
| | - R Z Pinto
- Sydney Medical School - Northern, University of Sydney & Royal North Shore Hospital, St Leonards, NSW, Australia
| | - F M Blyth
- School of Public Health, Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - J H McCauley
- Neuroscience Research Australia and School of Medical Sciences, University of NSW, Sydney, NSW, Australia
| | - C G Maher
- The George Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - R J E M Smeets
- Knowledge Centre Rehabilitation Foundation Limburg, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Caphri, Maastricht University, Maastricht, The Netherlands
| | - A McGarity
- Injury Management, Health & Safety Branch, NSW Fire and Safety, Sydney, Australia
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Gerdle B, Åkerblom S, Stålnacke BM, Brodda Jansen G, Enthoven P, Ernberg M, Dong HJ, Äng BO, Boersma K. The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation – a SQRP study of more than 20,000 chronic pain patients. Scand J Pain 2019; 19:693-711. [DOI: 10.1515/sjpain-2019-0016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/02/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up.
Methods
Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods.
Results
The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements.
Conclusions
Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP.
Implications
This study emphasizes the need to adopt a biopsychosocial perspective when assessing patients with chronic pain. Patients with chronic pain referred to specialist clinics are not homogenous in their clinical presentation. Instead we identified three distinct subgroups of patients. The outcomes of MMRP appears to be related to the clinical presentation. Thus, patients with the most severe clinical presentation show the most prominent improvements. However, even though this group of patients improve they still after MMRP show a complex situation and there is thus a need for optimizing the content of MMRP for these patients. The subgroup of patients with a relatively good situation with respect to pain, psychological distress, coping and life impact only showed minor improvements after MMRP. Hence, there is a need to develop other complex interventions for them.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences , Linköping University , SE-581 85 Linköping , Sweden , Phone: +46763927191
| | - Sophia Åkerblom
- Department of Pain Rehabilitation , Skåne University Hospital , Lund , Sweden
- Department of Psychology , Lund University , Lund , Sweden
| | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine , Umeå University , Umeå , Sweden
| | - Gunilla Brodda Jansen
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine , Stockholm , Sweden
| | - Paul Enthoven
- Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Malin Ernberg
- Department of Dental Medicine , Karolinska Institutet , Stockholm , Sweden
- Scandinavian Center for Orofacial Neuroscience (SCON) , Huddinge , Sweden
| | - Huan-Ji Dong
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Björn O Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , 23100 Huddinge , Sweden
- Center for Clinical Research Dalarna – Uppsala University , Falun , Sweden
- School of Education, Health and Social Studies , Dalarna University , Falun , Sweden
| | - Katja Boersma
- School of Law, Psychology and Social Work , Örebro University , Örebro , Sweden
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Petersen J, Kirkeskov L, Hansen BB, Begtrup LM, Flachs EM, Boesen M, Hansen P, Bliddal H, Kryger AI. Physical demand at work and sick leave due to low back pain: a cross-sectional study. BMJ Open 2019; 9:e026917. [PMID: 31122982 PMCID: PMC6537989 DOI: 10.1136/bmjopen-2018-026917] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/06/2019] [Accepted: 04/11/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To investigate if self-reported high physical demand at work, objective physical workload using a job exposure matrix (JEM) and fear-avoidance beliefs are associated with reported sick leave in the previous year in persons with low back pain (LBP). Second, to investigate if the effects of fear-avoidance and self-reported high physical demand at work on sick leave are modified by the objective physical workloads. SETTINGS Participants were recruited from general practice and by advertisement in a local newspaper. PARTICIPANTS 305participants with a current period of 2-4 weeks LBP and self-reported difficulty in maintaining physically demanding jobs due to LBP were interviewed, clinically examined and had an MRI at baseline. MAIN OUTCOME MEASURES Independent variables were high fear-avoidance, self-reported high physical demand at work and objective measures of physical workloads (JEM). Outcome was self-reported sick leave due to LBP in the previous year. Logistic regression and tests for interaction were used to identify risk factors and modifiers for the association with self-reported sick leave. RESULTS Self-reported physically demanding work and high fear-avoidance were significantly associated with prior sick leave due to LBP in the previous year with OR 1.75 95% CI (1.10 to 2.75) and 2.75 95% CI (1.61to 4.84), respectively. No objective physical workloads had significant associations. There was no modifying effect of objective physical workloads on the association between self-reported physical demand at work/high fear-avoidance and sick leave. CONCLUSIONS Occupational interventions to reduce sick leave due to LBP may have to focus more on those with high self-reported physical demands and high fear-avoidance, and less on individuals with the objectively highest physical workload. TRIAL REGISTRATION NUMBER NCT02015572; Post-results.
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Affiliation(s)
- Jonathan Petersen
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lilli Kirkeskov
- Department of Occupational and Environmental Medicine, Unit of Social Medicine, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Bjarke Brandt Hansen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Luise Moelenberg Begtrup
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Philip Hansen
- Department of Radiology, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henning Bliddal
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ann Isabel Kryger
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Beneciuk JM, George SZ, Greco CM, Schneider MJ, Wegener ST, Saper RB, Delitto A. Targeted interventions to prevent transitioning from acute to chronic low back pain in high-risk patients: development and delivery of a pragmatic training course of psychologically informed physical therapy for the TARGET trial. Trials 2019; 20:256. [PMID: 31060589 PMCID: PMC6501335 DOI: 10.1186/s13063-019-3350-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/03/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is a public health concern because it is highly prevalent and the leading cause of disability worldwide. Psychologically informed physical therapy (PIPT) is a secondary prevention approach that first aims to identify individuals at high risk for transitioning to chronicity and then provides tailored treatment to reduce that risk. Training models that are feasible to implement with acceptable training quality are needed to improve scalability for widespread implementation of PIPT. This manuscript describes the PIPT training program that was developed for training physical therapists providing PIPT in the TARGET trial. METHODS The PIPT training program was developed, tested, and modified using an iterative process. Content development consisted of stakeholder engagement, beta testing, modification of training, and confirmation of final course objectives. Methods of delivery consisted of a website that included brief online educational modules followed by a live 8-h workshop that included video-based mock case scenarios and case-based role playing. Attitudes, beliefs, and confidence in implementing PIPT principles were assessed before and immediately after training to measure training quality and impact. RESULTS Early stakeholder engagement and beta testing indicated the need for increased emphasis on experiential learning opportunities and patient-centered communication training. Booster training varied extensively across TARGET sites with involvement of 'clinician champions' providing brief follow-up sessions identified as best practice. Favorable post-training changes in physical therapist attitudes and beliefs toward biopsychosocial treatment orientation and increased confidence in implementing PIPT principles were observed. CONCLUSIONS PIPT training for provider participation in the TARGET trial was feasible to deliver. Course content was acceptable to physical therapists and resulted in improved beliefs and confidence in applying PIPT skills during clinical practice. Ongoing consultation and site-based continuing education were methods by which specific TARGET sites maintained or augmented PIPT skill training; however, implementing ongoing training was challenging in general. Due to the pragmatic nature of the TARGET trial, it was not possible to directly measure the effect of PIPT training on treatment fidelity, which was a limitation of our approach. TRIAL REGISTRATION ClinicalTrials.gov, NCT02647658 . Registered on 6 January 2016.
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Affiliation(s)
- Jason M. Beneciuk
- Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, Box 100154, UFHSC, Gainesville, FL 32610-0154 USA
- Brooks Rehabilitation, Clinical Research Center, 3901 University Blvd. South, Suite 103, Jacksonville, FL 32216 USA
| | - Steven Z. George
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, 2400 Pratt Street, Durham, NC 27705 USA
| | - Carol M. Greco
- Departments of Psychiatry, Rehabilitation Science and Technology, and Physical Therapy, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213 USA
| | - Michael J. Schneider
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Suite 210, Bridgeside Point 1, Pittsburgh, PA 15219 USA
| | - Stephen T. Wegener
- Department of Physical Medicine and Rehab, Johns Hopkins School of Medicine, Phipps 188, 600 N. Wolfe Str., Baltimore, MD 21287 USA
| | - Robert B. Saper
- Boston Medical Center Department of Family Medicine, 1 Boston Medical Center Place, Dowling 5 South, Boston, MA 02118 USA
| | - Anthony Delitto
- School of Health and Rehabilitation Sciences, University of Pittsburgh, 4229 Forbes Tower, Pittsburgh, PA 15260 USA
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191
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Schütze R, Rees C, Smith A, Slater H, Catley M, O’Sullivan P. Assessing Beliefs Underlying Rumination About Pain: Development and Validation of the Pain Metacognitions Questionnaire. Front Psychol 2019; 10:910. [PMID: 31080425 PMCID: PMC6497779 DOI: 10.3389/fpsyg.2019.00910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/04/2019] [Indexed: 01/30/2023] Open
Abstract
Metacognitions, which are beliefs about our own thinking processes, can modulate worry and rumination and thereby influence emotional distress. This study aimed to develop a self-report measure of unhelpful pain-related metacognitions which might serve as a clinical and research tool to better understand pain catastrophizing, a significant risk factor for adverse pain outcomes. Two phases of validation are presented. Phase 1 reports on how the Pain Metacognitions Questionnaire (PMQ) was empirically developed through a qualitative study of 20 people with chronic back (n = 15) or knee (n = 5) pain in secondary or tertiary care and then validated in a large internet sample of people experiencing pain (N = 864). Rasch analysis yielded a 21-item scale with two dimensions (positive and negative metacognition) assessing how useful and problematic people believe rumination about pain to be, respectively. In Phase 2, further validation using a new sample (N = 510) replicated initial findings. Both PMQ subscales have good retest reliability (r = 0.76, r = 0.72) and internal consistency (0.86, 0.87). They correlate negatively with mindfulness and positively with pain intensity, disability, anxiety, depression, catastrophizing, rumination, and metacognition. The PMQ also predicts unique variance in catastrophizing when other variables are controlled and predicts 'patient' status for pain catastrophizing. Sensitivity analysis yielded preliminary suggestions for clinically meaningful cut-offs. Unhelpful pain metacognitions can be validly and reliably measured using a self-report instrument. Future studies using the PMQ might shed new light on pain-related thinking processes to develop better interventions for people prone to worry and rumination about their pain.
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Affiliation(s)
- Robert Schütze
- School of Psychology, Curtin University, Perth, WA, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Clare Rees
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Mark Catley
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Peter O’Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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192
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Verburg AC, van Dulmen SA, Kiers H, Nijhuis-van der Sanden MWG, van der Wees PJ. Development of a standard set of outcome measures for non-specific low back pain in Dutch primary care physiotherapy practices: a Delphi study. 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 2019; 28:1550-1564. [PMID: 31004195 DOI: 10.1007/s00586-019-05962-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/22/2019] [Accepted: 03/24/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop a clinical standard set of outcome measures that are accepted for relevance and feasibility by stakeholders and useful for (a) interaction between patient and the professional, e.g. shared decision-making in goal-setting, monitoring and feedback based on outcomes, (b) internal quality improvement, and (c) external transparency in patients with non-specific low back pain (NSLBP) in primary care physical therapy. METHODS We used a consensus-driven modified RAND-UCLA Delphi method in seven steps with panellists (patients, representatives of patient and physiotherapy associations, researchers, policy makers, health insurers): (1) literature search, (2) first online survey, (3) patient interviews, (4) an experts meeting, (5) a consensus meeting, (6) second online survey, and (7) final approval of an advisory board. Steps 1-4 resulted in potential outcome measures. In the consensus meeting after discussion panellists voted for inclusion per measure. In the second online survey the final standard set was rated on relevance and feasibility on a 9-point Likert scale; when the median score was ≥ 7, the standard set was accepted and finally approved. RESULTS Thirteen draft outcome measures were rated and discussed, and finally, six outcome measures were accepted. The standard set includes the Quebec Back Pain Disability Scale, Oswestry Disability Index, Patient-Specific Functional Scale, Numeric Pain Rating Scale, Global Perceived Effect (GPE-DV), and the STarT Back Screening Tool (SBT). CONCLUSION This study presents a standard set of outcome measures for patients with NSLBP in primary care physiotherapy accepted for relevance and feasibility by stakeholders. The standard set is currently used in daily practice and tested on validity and reliability in a pilot study. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- A C Verburg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
| | - S A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - H Kiers
- Institute for Human Movement Studies, Utrecht University of Applied Sciences, Utrecht, The Netherlands
- Association for Quality in Physical Therapy (SKF), Zwolle, The Netherlands
| | - M W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - P J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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193
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The Role of a Decision Support System in Back Pain Diagnoses: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1314028. [PMID: 31019964 PMCID: PMC6452564 DOI: 10.1155/2019/1314028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/05/2019] [Indexed: 12/20/2022]
Abstract
It is the main goal of this study to investigate the concordance of a decision support system and the recommendation of spinal surgeons regarding back pain. 111 patients had to complete the decision support system. Furthermore, their illness was diagnosed by a spinal surgeon. The results showed significant medium relation between the DSS and the diagnosis of the medical doctor. Besides, in almost 50% of the cases the recommendation for the treatment was concordant and overestimation occurred more often than underestimation. The results are discussed in relation to the “symptom checker” literature and the claim of further evaluations.
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194
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Tribian A, Vinstrup J, Sundstrup E, Jay K, Bös K, Andersen LL. Physical activity during work and leisure show contrasting associations with fear-avoidance beliefs: cross-sectional study among more than 10,000 wage earners of the general working population. Scand J Pain 2019; 18:71-79. [PMID: 29794279 DOI: 10.1515/sjpain-2017-0136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/18/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS The association between different types of physical activity and fear-avoidance beliefs remains unclear. This study investigates the association between work-related and leisure-time physical activity with fear-avoidance beliefs in the general working population. METHODS Currently employed wage earners (n=10,427) from the 2010 round of the Danish Work Environment Cohort Study replied to questions about work, lifestyle and health. General linear models controlling for lifestyle, psychosocial work factors, education, pain, medication-use and chronic diseases tested associations of work-related and leisure-time physical activity (explanatory variables) with fear-avoidance beliefs (outcome variable, scale 0-100). RESULTS The level of fear-avoidance was 41.7 (SD 27.3), 38.0 (SD 26.9) and 54.3 (SD 27.7) among the general working population, a subgroup of pain-free individuals, and a subgroup with back disease, respectively. In the general working population, the level of fear-avoidance among those with low, moderate and high physical activity during leisure were 47 [95% confidence intervals (CI) 45-49], 44 (95% CI 42-46) and 43 (95% CI 41-45), and physical activity at work were 40 (95% CI 39-42), 44 (95% CI 42-46) and 49 (95% CI 48-51), respectively. Individuals with back disease and a high level of physical activity at work showed the overall highest level of fear-avoidance whereas pain-free individuals with a low level of physical activity at work showed the overall lowest level of fear-avoidance. CONCLUSIONS Physical activity during work and leisure shows contrasting associations with fear-avoidance beliefs. While high physical activity during leisure is associated with lower levels, high physical activity at work is associated with higher levels of fear-avoidance. IMPLICATIONS The present results may reflect some deeply rooted negative beliefs about pain and work in the population. On the societal level, campaigns may be a possible way forward as these have shown to improve beliefs about musculoskeletal pain and work.
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Affiliation(s)
- Annika Tribian
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Jonas Vinstrup
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Physical Activity and Human Performance Group, SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Emil Sundstrup
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Kenneth Jay
- National Research Centre for the Working Environment, Copenhagen, Denmark.,The Carrick Institute - Clinical Neuroscience and Rehabilitation, Cape Canaveral, FL, USA
| | - Klaus Bös
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Lars L Andersen
- Physical Activity and Human Performance Group, SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen, Denmark, Phone: +45 3916 5319
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195
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Yoshimoto T, Oka H, Fujii T, Kawamata K, Kokaze A, Koyama Y, Matsudaira K. Survey on chronic disabling low back pain among care workers at nursing care facilities: a multicenter collaborative cross-sectional study. J Pain Res 2019; 12:1025-1032. [PMID: 31118745 PMCID: PMC6498961 DOI: 10.2147/jpr.s188125] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/18/2019] [Indexed: 01/22/2023] Open
Abstract
Purpose: Care workers at nursing care facilities have a high rate of low back pain (LBP). Although increasing evidence has revealed the important role of psychosocial factors in chronic LBP, factors associated with chronic LBP interfering with work have not been fully investigated in Japanese workers at nursing care facilities. The present study aimed to determine the prevalence of chronic LBP interfering with work and related factors of chronic LBP including psychosocial factors, among workers at nursing care facilities. Material and methods: Eligible participants in the present study were Japanese workers at 95 nursing care facilities in Ishikawa Prefecture (n=2,242). Of these, 1,345 participants completed a self-administered questionnaire that included the following items: individual characteristics, severity of LBP, sleep problem, fear-avoidance beliefs (Tampa Scale for Kinesiophobia: TSK), STarT Back Screening Tool (SBST), fatigue, somatizing tendency, and work-related stress such as job satisfaction, job demand, interpersonal stress at work, and social support. The logistic regression analysis was used to assess factors associated with chronic disabling LBP. Results: Of participants who completed the questionnaires, 159 (11.8%) reported chronic LBP that interfered with their work. The multivariable analysis of related-factors of chronic disabling LBP found statistically significant associations with the following: high score of psychological subscale in SBST (adjusted odds ratio [aOR]: 5.83, 95% confidence interval [CI]: 3.55–9.59), high score of TSK (aOR: 1.08, 95% CI: 1.05–1.13), and high somatizing tendency (aOR: 2.07, 95% CI: 1.31–3.23). Conclusion: Psychological factors, including fear-avoidance beliefs or somatizing tendency, showed significant association with chronic LBP that interfered with work, among workers at nursing care facilities. Our results suggest that these factors would need to be considered in addition to screening for the risk factors of LBP chronicity by SBST when evaluating workers with chronic disabling LBP.
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Affiliation(s)
- Takahiko Yoshimoto
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Tokyo, Japan.,Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Fujii
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kayo Kawamata
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akatsuki Kokaze
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshiko Koyama
- Department of Physical Therapy, Faculty of Health Sciences, Kinjo University, Ishikawa, Japan.,Ishikawa Occupational Health Support Center, Ishikawa, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Williams A, Lee H, Kamper SJ, O'Brien KM, Wiggers J, Wolfenden L, Yoong SL, Hodder RK, Robson EK, Haskins R, McAuley JH, Williams CM. Causal mechanisms of a healthy lifestyle intervention for patients with musculoskeletal pain who are overweight or obese. Clin Rehabil 2019; 33:1088-1097. [PMID: 30808203 DOI: 10.1177/0269215519831419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the causal mechanisms of a healthy lifestyle intervention for patients with chronic low back pain and knee osteoarthritis, who are overweight or obese. METHODS We conducted causal mediation analyses of aggregated data from two randomized controlled trials (RCTs); which included 160 patients with chronic low back pain, and 120 patients with knee osteoarthritis. The intervention consisted of brief advice and referral to a six-month telephone-based healthy lifestyle coaching service. We used causal mediation to estimate the indirect, direct and path-specific effects of hypothesized mediators including: self-reported weight, diet, physical activity, and pain beliefs. Outcomes were pain intensity, disability, and quality of life (QoL). RESULTS The intervention did not reduce weight, improve diet or physical activity or change pain beliefs, and these mediators were not associated with the outcomes. Sensitivity analyses showed that our estimates were robust to the possible effects of unknown and unmeasured confounding. CONCLUSIONS Our findings show that the intervention did not cause a meaningful change in the hypothesized mediators, and these mediators were not associated with patient-reported outcomes.
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Affiliation(s)
- Amanda Williams
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia.,3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia
| | - Hopin Lee
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia.,4 Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.,5 Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Steven J Kamper
- 3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia.,6 School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Kate M O'Brien
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia.,3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia
| | - John Wiggers
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Luke Wolfenden
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Sze L Yoong
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Rebecca K Hodder
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia.,3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia
| | - Emma K Robson
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia.,3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia
| | - Robin Haskins
- 7 Outpatient Services, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - James H McAuley
- 4 Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.,8 School of Medical Sciences, Faculty of Medicine, University of NSW, Sydney, NSW, Australia
| | - Christopher M Williams
- 1 School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,2 Hunter New England Population Health, Wallsend, NSW, Australia.,3 Centre for Pain, Health and Lifestyle, Newcastle, NSW, Australia
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198
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Pain-Related Fear-Dissociable Neural Sources of Different Fear Constructs. eNeuro 2019; 5:eN-NWR-0107-18. [PMID: 30627654 PMCID: PMC6325558 DOI: 10.1523/eneuro.0107-18.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/03/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022] Open
Abstract
Fear of pain demonstrates significant prognostic value regarding the development of persistent musculoskeletal pain and disability. Its assessment often relies on self-report measures of pain-related fear by a variety of questionnaires. However, based either on “fear of movement/(re)injury/kinesiophobia,” “fear avoidance beliefs,” or “pain anxiety,” pain-related fear constructs plausibly differ while it is unclear how specific the questionnaires are in assessing these different constructs. Furthermore, the relationship of pain-related fear to other anxiety measures such as state or trait anxiety remains ambiguous. Advances in neuroimaging such as machine learning on brain activity patterns recorded by functional magnetic resonance imaging might help to dissect commonalities or differences across pain-related fear constructs. We applied a pattern regression approach in 20 human patients with nonspecific chronic low back pain to reveal predictive relationships between fear-related neural pattern information and different pain-related fear questionnaires. More specifically, the applied multiple kernel learning approach allowed the generation of models to predict the questionnaire scores based on a hierarchical ranking of fear-related neural patterns induced by viewing videos of activities potentially harmful for the back. We sought to find evidence for or against overlapping pain-related fear constructs by comparing the questionnaire prediction models according to their predictive abilities and associated neural contributors. By demonstrating evidence of nonoverlapping neural predictors within fear-processing regions, the results underpin the diversity of pain-related fear constructs. This neuroscientific approach might ultimately help to further understand and dissect psychological pain-related fear constructs.
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199
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Wippert PM, Arampatzis A, Banzer W, Beck H, Hasenbring MI, Schiltenwolf M, Schneider C, Stengel D, Platen P, Mayer F. Psychosoziale Risikofaktoren in der Entstehung von chronisch unspezifischen Rückenschmerzen. ZEITSCHRIFT FUR SPORTPSYCHOLOGIE 2019. [DOI: 10.1026/1612-5010/a000245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Zusammenfassung. Chronisch unspezifische Rückenschmerzen (CURS) gehören international zu den häufigsten Schmerzphänomenen und können für Athletinnen und Athleten karrierelimitierend sein. Knapp ein Drittel der jährlichen Trainingsausfallzeiten werden auf CURS zurückgeführt. In der Entstehung von chronischen Schmerzen ist ein multifaktorielles Ätiologiemodell mit einem signifikanten Einfluss psychosozialer Risikofaktoren evident. Obwohl dies in der Allgemeinbevölkerung bereits gut erforscht ist, gibt es in der Sportwissenschaft vergleichsweise wenige Arbeiten darüber. Dieses Thema wird daher in drei Multicenterstudien und zahlreichen Teilstudien des MiSpEx-Netzwerks ( Medicine in Spine-Exercise-Network, Förderzeitraum 2011 – 2018) aufgegriffen. Entsprechend der Empfehlung einer frühzeitigen Diagnostik von Chronifizierungsfaktoren in der „Nationalen Versorgungsleitlinie Kreuzschmerz“, beschäftigt sich das Netzwerk u. a. mit der Überprüfung, Entwicklung und Evaluation diagnostischer Möglichkeiten. Der vorliegende Beitrag beschreibt die Entwicklung einer Diagnostik von psychosozialen Risikofaktoren, die einerseits eine Einschätzung des Risikos der Entwicklung von CURS und andererseits eine individuelle Zuweisung zu (Trainings)Interventionen erlaubt. Es wird die Entwicklungsrationale beschrieben und dabei verschiedene methodische Herangehensweisen und Entscheidungssequenzen reflektiert.
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Affiliation(s)
| | - Adamantios Arampatzis
- Department für Trainings- und Bewegungswissenschaften, Humboldt-Universität zu Berlin
| | - Winfried Banzer
- Abteilung für Trainings- und Sportmedizin, Goethe-Universität Frankfurt am Main
| | - Heidrun Beck
- Centrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | - Christian Schneider
- Sportorthopädisches Institut der Schön Klinik München Harlaching
- Orthopädiezentrum Theresie, München
| | - Dirk Stengel
- Zentrum für Klinische Forschung, Unfallkrankenhaus Berlin
| | - Petra Platen
- Fakultät für Sportwissenschaft, Sportmedizin und Sporternährung, Ruhr-Universität Bochum
| | - Frank Mayer
- Zentrum für Sportmedizin, Universität Potsdam, Hochschulambulanz
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200
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Suni JH, Kolu P, Tokola K, Raitanen J, Rinne M, Taulaniemi A, Parkkari J, Kankaanpää M. Effectiveness and cost-effectiveness of neuromuscular exercise and back care counseling in female healthcare workers with recurrent non-specific low back pain: a blinded four-arm randomized controlled trial. BMC Public Health 2018; 18:1376. [PMID: 30558592 PMCID: PMC6296156 DOI: 10.1186/s12889-018-6293-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 12/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Registered healthcare workers worldwide have a high prevalence of work-related musculoskeletal disorders, particularly of the back. Multidisciplinary interventions among these workers have improved fear avoidance beliefs, but not low back pain (LBP) and related sickness absences, cost-effectiveness studies are scarce. Our purpose was to investigate the effectiveness and cost-effectiveness of three intervention-arms (combined neuromuscular exercise and back care counselling or either alone) compared with non-treatment. Methods We randomly assigned female healthcare workers with recurrent non-specific LBP to one of four study-arms: Combined neuromuscular exercise and back care counseling; Exercise; Counseling; and no intervention Control. We assessed the effectiveness of the interventions on intensity of LBP, pain interfering with work and fear avoidance beliefs against the Control, and calculated the incremental cost-effectiveness ratios for sickness absence and QALY. Results We conducted three sub-studies in consecutive years of 2011, 2012, and 2013 to reach an adequate sample size. All together 219 women were randomized within each sub-study, of whom 74 and 68% had adequate questionnaire data at 6 and 12 months, respectively. No adverse events occurred. Compliance rates varied between intervention-arms. After 12 months, the Combined-arm showed reduced intensity of LBP (p = 0.006; effect size 0.70, confidence interval 0.23 to 1.17) and pain interfering with work (p = 0.011) compared with the Control-arm. Work-related fear of pain was reduced in both the Combined- (p = 0.003) and Exercise-arm (p = 0.002). Physical activity-related fear was reduced only in the Exercise-arm (p = 0.008). During the study period (0–12 months) mean total costs were lowest in the Combined-arm (€476 vs. €1062–€1992, p < 0.001) as were the mean number of sickness absence days (0.15 vs. 2.29–4.17, p = 0.025). None of the intervention-arms was cost-effective for sickness absence. There was 85% probability of exercise-arm being cost-effective if willing to pay €3550 for QALY gained. Conclusions Exercise once a week for 6 months combined with five sessions of back care counseling after working hours in real-life settings effectively reduced the intensity of LBP, work interference due to LBP, and fear of pain, but was not cost-effective. Trial registration ClinicalTrials.gov, NCT01465698 November 7, 2011 (prospective). Electronic supplementary material The online version of this article (10.1186/s12889-018-6293-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaana Helena Suni
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland.
| | - Päivi Kolu
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Kari Tokola
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Jani Raitanen
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland.,Faculty of Social Sciences (Health Sciences), University of Tampere, Kalevantie 4, 33100, Tampere, Finland
| | - Marjo Rinne
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Annika Taulaniemi
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Jari Parkkari
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Markku Kankaanpää
- Pirkanmaa Hospital District, Physical and Rehabilitation Medicine Outpatient Clinic, Teiskontie 35, 33520, Tampere, Finland
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