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Mauck MC, Aylward AF, Barton CE, Birckhead B, Carey T, Dalton DM, Fields AJ, Fritz J, Hassett AL, Hoffmeyer A, Jones SB, McLean SA, Mehling WE, O'Neill CW, Schneider MJ, Williams DA, Zheng P, Wasan AD. [Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach : German version]. Schmerz 2024:10.1007/s00482-024-00798-x. [PMID: 38381187 DOI: 10.1007/s00482-024-00798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Back Pain Research Consortium, part of the National Institutes of Health Helping to End Addiction Long-termSM (HEAL) Initiative, will conduct a collaborative clinical trial, which seeks to develop a personalized medicine algorithm to optimize patient and provider treatment selection for patients with cLBP. OBJECTIVE The primary objective of this article is to provide an update on evidence-based cLBP interventions and describe the process of reviewing and selecting interventions for inclusion in the clinical trial. METHODS A working group of cLBP experts reviewed and selected interventions for inclusion in the clinical trial. The primary evaluation measures were strength of evidence and magnitude of treatment effect. When available in the literature, duration of effect, onset time, carryover effect, multimodal efficacy, responder subgroups, and evidence for the mechanism of treatment effect or biomarkers were considered. CONCLUSION The working group selected 4 leading, evidence-based treatments for cLBP to be tested in the clinical trial and for use in routine clinical treatment. These treatments include (1) duloxetine, (2) acceptance and commitment therapy, (3) a classification-based exercise and manual therapy intervention, and (4) a self-management approach. These interventions each had a moderate to high level of evidence to support a therapeutic effect and were from different therapeutic classes.
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Affiliation(s)
- Matthew C Mauck
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA.
| | - Aileen F Aylward
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chloe E Barton
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA
| | - Brandon Birckhead
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Timothy Carey
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diane M Dalton
- Department of Physical Therapy, Boston University, College of Health and Rehabilitation Sciences, Sargent, Boston, MA, USA
| | - Aaron J Fields
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, Kalifornien, USA
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Anna Hoffmeyer
- University of North Carolina at Chapel Hill, Collaborative Studies Coordinating Center, Chapel Hill, NC, USA
| | - Sara B Jones
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA
| | - Wolf E Mehling
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, Kalifornien, USA
| | - Conor W O'Neill
- Section of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, Kalifornien, USA
| | - Michael J Schneider
- Department of Physical Therapy and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Patricia Zheng
- Section of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, Kalifornien, USA
| | - Ajay D Wasan
- Departments of Anesthesiology and Perioperative Medicine and Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Edwards KA, Reed DE, Anderson D, Harding K, Turner AP, Soares B, Suri P, Williams RM. Opening the black box of psychological treatments for chronic pain: A clinical perspective for medical providers. PM R 2023; 15:999-1011. [PMID: 36633497 DOI: 10.1002/pmrj.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Karlyn A Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University, Stanford, California, USA
| | - David E Reed
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Administration Puget Sound Health Care, Seattle, Washington, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Derek Anderson
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
| | - Kaitlin Harding
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
| | - Aaron P Turner
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Bosco Soares
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Pradeep Suri
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, Washington, USA
| | - Rhonda M Williams
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
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Maschke M, Diener HC. [Chronic Back Pain]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:326-339. [PMID: 37463575 DOI: 10.1055/a-2055-5322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Chronic back pain is one of the most common diseases in Germany. In many cases, no morphological change is found, so that the genesis remains unspecific in over 90% of patients. This article is intended to provide an overview of drug therapy as well as non-drug measures and summarizes the corresponding guideline recommendations.
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Oyake K, Yamauchi K, Inoue S, Sue K, Ota H, Ikuta J, Ema T, Ochiai T, Hasui M, Hirata Y, Hida A, Yamamoto K, Kawai Y, Shiba K, Atsumi A, Nagafusa T, Tanaka S. A multicenter explanatory survey of patients' and clinicians' perceptions of motivational factors in rehabilitation. COMMUNICATIONS MEDICINE 2023; 3:78. [PMID: 37280319 DOI: 10.1038/s43856-023-00308-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Patient motivation is an important determinant of rehabilitation outcomes. Differences in patients' and clinicians' perceptions of motivational factors can potentially hinder patient-centered care. Therefore, we aimed to compare patients' and clinicians' perceptions of the most important factors in motivating patients for rehabilitation. METHODS This multicenter explanatory survey research was conducted from January to March 2022. In 13 hospitals with an intensive inpatient rehabilitation ward, 479 patients with neurological or orthopedic disorders undergoing inpatient rehabilitation and 401 clinicians, including physicians, physical therapists, occupational therapists, and speech-language-hearing therapists, were purposively selected using inclusion criteria. The participants were asked to choose the most important factor motivating patients for rehabilitation from a list of potential motivational factors. RESULTS Here we show that realization of recovery, goal setting, and practice related to the patient's experience and lifestyle are the three factors most frequently selected as most important by patients and clinicians. Only five factors are rated as most important by 5% of clinicians, whereas nine factors are selected by 5% of patients. Of these nine motivational factors, medical information (p < 0.001; phi = -0.14; 95% confidence interval = -0.20 to -0.07) and control of task difficulty (p = 0.011; phi = -0.09; 95% confidence interval = -0.16 to -0.02) are selected by a significantly higher proportion of patients than clinicians. CONCLUSIONS These results suggest that when determining motivational strategies, rehabilitation clinicians should consider individual patient preferences in addition to using the core motivational factors supported by both parties.
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Affiliation(s)
- Kazuaki Oyake
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Nagano, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Katsuya Yamauchi
- Department of Rehabilitation Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Seigo Inoue
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Keita Sue
- Department of Rehabilitation, JA Nagano Kouseiren Kakeyu-Misayama Rehabilitation Center Kakeyu Hospital, Nagano, Japan
| | - Hironobu Ota
- Rehabilitation Center, Aichi Medical University Medical Center, Aichi, Japan
| | - Junichi Ikuta
- Division of Occupational Therapy, Department of Rehabilitation, Nakaizu Rehabilitation Center, Shizuoka, Japan
| | - Toshiki Ema
- Department of Rehabilitation, Suzukake Central Hospital, Shizuoka, Japan
| | - Tomohiko Ochiai
- Rehabilitation Center, Juzen Memorial Hospital, Shizuoka, Japan
| | - Makoto Hasui
- Department of Rehabilitation Medicine, JA Shizuoka Kohseiren Enshu Hospital, Shizuoka, Japan
| | - Yuya Hirata
- Department of Rehabilitation, Suzukake Healthcare Hospital, Shizuoka, Japan
| | - Ayaka Hida
- Department of Rehabilitation Medicine, Kakegawa Higashi Hospital, Shizuoka, Japan
| | - Kenta Yamamoto
- Department of Rehabilitation, Toyoda Eisei Hospital, Shizuoka, Japan
| | - Yoshihiro Kawai
- Department of Rehabilitation, Tenryu Suzukake Hospital, Shizuoka, Japan
| | - Kiyoto Shiba
- Department of Rehabilitation Medicine, Hamakita Sakuradai Hospital, Shizuoka, Japan
| | - Akihito Atsumi
- Department of Rehabilitation, Hamamatsu-Kita Hospital, Shizuoka, Japan
| | - Tetsuyuki Nagafusa
- Department of Rehabilitation Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Satoshi Tanaka
- Laboratory of Psychology, Hamamatsu University School of Medicine, Shizuoka, Japan.
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Chawla JK, Sushil P, Kumar P. Translation and Validation of Low Back Pain Knowledge Questionnaire Among Hindi-Speaking Indian Women. J Pain Palliat Care Pharmacother 2023:1-10. [PMID: 36716286 DOI: 10.1080/15360288.2023.2169432] [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: 02/01/2023]
Abstract
Low back pain (LBP) is a common problem encountered among women worldwide. This research aimed at the cross-cultural translation, adaptation, and equivalence assessment of the Low Back Pain Knowledge Questionnaire (LBPKQ) in the Hindi language. The LBPKQ, originally in English (E-LBPKQ) was translated and validated in the Hindi language (H-LBPKQ). The forward-backward procedure was adapted from the recommended guidelines for cross-cultural adaptation of measures. Psychometric properties of the H-LBPKQ were evaluated among 250 Hindi-speaking Indian women with LBP. Test-retest reliability was evaluated in the first 161 participants of the study sample. The overall LBPKQ scores obtained a mean of 3.1 ± 1.1. The internal consistency was excellent for both E-LBPKQ and H-LBPKQ, with Cronbach's alpha of 0.983 (95% confidence interval [CI], 0.980-0.986) and 0.975 (95% CI, 0.970-0.979), respectively. Construct validity was good, with Kaiser-Meyer-Olkin value of 0.892 for E-LBPKQ and 0.852 for H-LBPKQ. Bartlett's test of sphericity (P < .0001) was significant for E-LBPKQ and H-LBPKQ. Two factors were extracted through principal component analysis. The H-LBPKQ is valid and reliable to assess LBP knowledge among Hindi speaking population. Low LBPKQ scores indicate poor LBP knowledge; hence, LBP sensitization is needed among Indian women.
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Ahmadzadeh Amiri A, Genevay S, Ahmadzadeh Amiri A, Daneshvar F, Yazdani Charati J, Ghafouri M, Moghadam N, Kordi R. Adding a back care package to the primary healthcare; a community-based cluster-randomized trial. BRAIN & SPINE 2023; 3:101714. [PMID: 37383449 PMCID: PMC10293304 DOI: 10.1016/j.bas.2023.101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 06/30/2023]
Abstract
Introduction The clinical course of LBP is complex and chronicity is more frequent than once thought. Moreover, insufficient evidence was found in support of any specific approach at the level of the general population. Research question This study aimed to evaluate the effectiveness of providing a back care package through the primary healthcare system in decreasing the rate of CLBP in the community. Material and methods Clusters were primary healthcare units with the covered population as participants. The intervention package comprised both exercise and educational content in the form of booklets. Data regarding LBP were collected at baseline, 3 and 9-month follow-ups. The LBP prevalence and the incidence of CLBP in the intervention group compared to the control group were analyzed using logistic regression through GEE. Results Eleven clusters were randomized including 3521 enrolled subjects. At 9 months, the intervention group showed a statistically significant decrease in both the prevalence and the incidence of CLBP, compared to the control group (OR = 0.44; 95% CI = 0.30-0.65; P < 0.001 and OR = 0.48; 95% CI = 0.31-0.74; P < 0.001, respectively). Discussion and conclusion The population-based intervention was effective in reducing the LBP prevalence and CLBP incidence. Our results suggest that preventing CLBP through a primary healthcare package including exercise and educational content is achievable.
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Affiliation(s)
- Ali Ahmadzadeh Amiri
- Sports Medicine Research Center, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Stéphane Genevay
- Division of Rheumatology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Amir Ahmadzadeh Amiri
- Sports Medicine Research Center, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Daneshvar
- Department of Public Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jamshid Yazdani Charati
- Health Sciences Research Center, Biostatistics Department, Addiction Institute, School of Public Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Ghafouri
- Sports Medicine Research Center, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Navid Moghadam
- Sports Medicine Research Center, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran
- Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Kordi
- Sports Medicine Research Center, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran
- Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Garg B, George J, Mehta N. Reply to letter: Narrative approaches to reviews. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:68. [PMID: 37615129 DOI: 10.25259/nmji_920_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Jaiben George
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Nishank Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Patterson T, Turner J, Gnjidic D, Mintzes B, Bennett C, Bywaters L, Clavisi O, Baysari M, Ferreira M, Beckenkamp P, Ferreira P. (C)onsumer focused (E)ducation on p(A)racetamol (S)ide (E)ffects, i(N)adequate (O)utcomes and (W)eaning (CEASE NOW) for individuals with low back pain: results of a feasibility study. BMJ Open 2022; 12:e068164. [PMID: 36424116 PMCID: PMC9693669 DOI: 10.1136/bmjopen-2022-068164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To determine the feasibility of a patient-education booklet to support patients with low back pain (LBP) to reduce paracetamol intake. DESIGN Single group, repeated measures feasibility study. SETTING Community. PARTICIPANTS Adults experiencing LBP of any kind and self-reporting consumption of paracetamol for LBP weekly for at least 1 month were invited to participate. INTERVENTION Participants received a patient-education booklet 1 week after the baseline measures were collected. The intervention was designed to change beliefs, increase knowledge and self-efficacy to deprescribe paracetamol for their LBP and create discussion with a health professional through the mechanisms of motivation, capacity and opportunity. PRIMARY OUTCOME MEASURES Feasibility of recruitment procedures, data collection and acceptability of the intervention. SECONDARY OUTCOME MEASURES Changes in motivation, self-efficacy, opportunity to deprescribe paracetamol for their LBP, paracetamol usage and LBP clinical outcomes at baseline, 1-week and 1-month follow-up. RESULTS A total of 24 participants were recruited into the study within the timeframe of 3 months from study advertisement and all completed the study follow-up. There were no missing data for any outcome measure across all follow-up points, 22 (91.6%) participants were willing to participate in a future randomised control trial (RCT) and over 60% of participants responded positively to questions regarding acceptability of the patient-educational booklet. Overall, at the 1-month follow-up, approximately two thirds (15/24) of participants had an increase in motivation and self-efficacy scores and had discussed or intended to discuss their paracetamol use for LBP with a health professional. CONCLUSIONS The results of this study demonstrate that the patient-education booklet is feasible to implement, and both the intervention and study design were well-received by participants. This study supports the undertaking an RCT to assess the effects of the patient-education booklet on deprescribing paracetamol in people with LBP.
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Affiliation(s)
- Thomas Patterson
- The University of Sydney, Musculoskeletal Research Hub, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Justin Turner
- School of Pharmacy, University of Montreal, Montreal, Québec, Canada
| | - Danijela Gnjidic
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Barbara Mintzes
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Carol Bennett
- painaustralia, Deakin, Australian Capital Territory, Australia
| | - Lisa Bywaters
- Musculoskeletal Australia, Elsternwick, Victoria, Australia
| | | | - Melissa Baysari
- The University of Sydney, Discipline of Biomedical Informatics and Digital Health, Medicine and Health, Charles Perkins Centre, Camperdown, New South Wales, Australia
| | - Manuela Ferreira
- The University of Sydney, Institute of Bone and Joint, Kolling Institute, Faculty of Medicine and Health, St Leonards, New South Wales, Australia
| | - Paula Beckenkamp
- The University of Sydney, Musculoskeletal Research Hub, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Paulo Ferreira
- The University of Sydney, Musculoskeletal Research Hub, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
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Alamam D, Alhowimel A, Alodaibi F, Alsobayel H. Are healthcare providers offering the proper education for people with low back pain? Content analysis of educational materials. J Back Musculoskelet Rehabil 2022; 35:1269-1276. [PMID: 35599466 DOI: 10.3233/bmr-210232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Low back pain (LBP) is a prevalent disorder and leading cause of disability worldwide. In Saudi Arabia, patients with LBP are dispensed with educational materials to supposedly facilitate their recuperation. OBJECTIVE Appraise the suitability of educational materials provided for people with LBP in Saudi Arabia to determine whether they meet the needs of patients, inform self-management, and are consistent with clinical practice guidelines. METHODS A qualitative data collection method was used, and content analyses were conducted to analyse data based on manifest content. Educational items in English and Arabic were collected from relevant health providers in Saudi Arabia. RESULTS Seventeen educational materials were sourced from: Ministry of Health hospitals (n= 10), military hospitals (n= 4), private hospitals (n= 2), and a multidisciplinary healthcare association (n= 1). Six identified sub-themes comprise: epidemiological/anatomical data about LBP (n= 6); causes/risk factors (n= 10); exercise (n= 14) and physical activity-related (n= 3) recommendations; treatment-related recommendations (n= 2); general health and lifestyle-related recommendations (n= 8); and postural and ergonomics-related recommendations (n= 13). A common theme emerged, that 'the content of educational materials hindered reassurance and self-management for people with LBP.' CONCLUSION The reviewed educational materials fail to adequately report information that assure patients or inform their self-management among the Saudi population with LBP. Further, reviewed items are heavily influenced by the biomedical model of pain.
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Affiliation(s)
- Dalyah Alamam
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Alhowimel
- Department of Health and Rehabilitation Science, Prince Sattam bin Abdulaziz University, Alkarj, Kingdom of Saudi Arabia
| | - Faris Alodaibi
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hana Alsobayel
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Research Chair for Health Care Innovation, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Rim M, Leila R, Aicha BT, Olfa S, Meriem H, Ines L, Najla M, Hajer R, Imen K. Efficiency of Associating Therapeutic Patient Education with Rehabilitation in the Management of Chronic Low Back Pain: A Randomized Controlled Trial. Korean J Fam Med 2022; 43:367-373. [PMID: 36444121 PMCID: PMC9708858 DOI: 10.4082/kjfm.21.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/21/2022] [Accepted: 04/08/2022] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND This study aimed to assess the benefits of associating rehabilitation with therapeutic patient education (TPE) to decrease fear-avoidance belief and pain and improve function in adults with chronic low back pain (CLBP). METHODS This randomized controlled study included 100 patients with CLBP according to the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The patients were divided into two teams: group A that participated in the TPE in association with rehabilitation and group B that received rehabilitation only. Pain and functional amelioration were assessed initially (T0) and at the end of the program (T1) using a visual analog scale at rest, work, and activity, and the Echelle d'Incapacité Fonctionnelle pour l'Évaluation des Lombalgies scale. Psychological and apprehension and avoidance assessments were also conducted, including the evaluation of depression, anxiety, fear-avoidance belief, and kinesiophobia using the Hospital Anxiety and Depression Scale, Fear-Avoidance Beliefs Questionnaire, and Tampa scale of kinesiophobia scale. RESULTS The evaluation of progression initially (T0) and then at the end of the program (T1) revealed a significant reduction in pain at rest (P=0.00) and while working (P=0.00) and doing physical activity (P=0.03); a decrease in anxiety (P=0.03), fear-avoidance belief (P=0.03), and kinesiophobia (P=0.02); and an improvement in function (P=0.00) for patients in group A without amelioration of depression (P=0.15). Concerning group B, we identified a significant regression in pain at rest (P=0.001) and while working (P=0.03) and doing physical activity (P=0.00); depression (P=0.01); fear-avoidance beliefs (P=0.00); and kinesiophobia (P=0.002). Comparison between the groups revealed that associating TPE with rehabilitation resulted in a more significant improvement in function (P=0.00), anxiety (P=0.00), fear-avoidance belief (P=0.00), and kinesiophobia (P=0.00). CONCLUSION Associating TPE with rehabilitation improved function and reduced fear, false beliefs, and kinesiophobia of movement in patients with CLBP.
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Affiliation(s)
- Maaoui Rim
- Department of Physical and Rehabilitation Medicine, Military Tunis Hospital, Tunis, Tunisia
- Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Rouached Leila
- Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ben Tekaya Aicha
- Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Saidane Olfa
- Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
- Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hfaiedh Meriem
- Department of Physical and Rehabilitation Medicine, Military Tunis Hospital, Tunis, Tunisia
- Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Lajnef Ines
- Department of Physical and Rehabilitation Medicine, Military Tunis Hospital, Tunis, Tunisia
- Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mouhli Najla
- Department of Physical and Rehabilitation Medicine, Military Tunis Hospital, Tunis, Tunisia
- Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Rahali Hajer
- Department of Physical and Rehabilitation Medicine, Military Tunis Hospital, Tunis, Tunisia
- Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ksibi Imen
- Department of Physical and Rehabilitation Medicine, Military Tunis Hospital, Tunis, Tunisia
- Faculté de Médecine de Tunis, Tunis El Manar University, Tunis, Tunisia
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Furlong B, Etchegary H, Aubrey-Bassler K, Swab M, Pike A, Hall A. Patient education materials for non-specific low back pain and sciatica: A systematic review and meta-analysis. PLoS One 2022; 17:e0274527. [PMID: 36223377 PMCID: PMC9555681 DOI: 10.1371/journal.pone.0274527] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/28/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Guidelines recommend patient education materials (PEMs) for low back pain (LBP), but no systematic review has assessed PEMs on their own. We investigated the effectiveness of PEMs on process, clinical, and health system outcomes for LBP and sciatica. METHODS Systematic searches were performed in MEDLINE, EMBASE, CINAHL, PsycINFO, SPORTDiscus, trial registries and grey literature through OpenGrey. We included randomized controlled trials of PEMs for LBP. Data extraction, risk of bias, and quality of evidence gradings were performed independently by two reviewers. Standardized mean differences or risk ratios and 95% confidence intervals were calculated, and effect sizes pooled using random-effects models. Analyses of acute/subacute LBP were performed separately from chronic LBP at immediate, short, medium, and long-term (6, 12, 24, and 52 weeks, respectively). RESULTS 27 studies were identified. Compared to usual care for chronic LBP, we found moderate to low-quality evidence that PEMs improved pain intensity at immediate (SMD = -0.16 [95% CI: -0.29, -0.03]), short (SMD = -0.44 [95% CI: -0.88, 0.00]), medium (SMD = -0.53 [95% CI: -1.01, -0.05]), and long-term (SMD = -0.21 [95% CI: -0.41, -0.01]), medium-term disability (SMD = -0.32 [95% CI: -0.61, -0.03]), quality of life at short (SMD = -0.17 [95% CI: -0.30, -0.04]) and medium-term (SMD = -0.23 [95% CI: -0.41, -0.04]) and very low-quality evidence that PEMs improved global improvement ratings at immediate (SMD = -0.40 [95% CI: -0.58, -0.21]), short (SMD = -0.42 [95% CI: -0.60, -0.24]), medium (SMD = -0.46 [95% CI: -0.65, -0.28]), and long-term (SMD = -0.43 [95% CI: -0.61, -0.24]). We found very low-quality evidence that PEMs improved pain self-efficacy at immediate (SMD = -0.21 [95% CI: -0.39, -0.03]), short (SMD = -0.25 [95% CI: -0.43, -0.06]), medium (SMD = -0.23 [95% CI: -0.41, -0.05]), and long-term (SMD = -0.32 [95% CI: -0.50, -0.13]), and reduced medium-term fear-avoidance beliefs (SMD = -0.24 [95% CI: -0.43, -0.06]) and long-term stress (SMD = -0.21 [95% CI: -0.39, -0.03]). Compared to usual care for acute LBP, we found high to moderate-quality evidence that PEMs improved short-term pain intensity (SMD = -0.24 [95% CI: -0.42, -0.06]) and immediate-term quality of life (SMD = -0.24 [95% CI: -0.42, -0.07]). We found low to very low-quality evidence that PEMs increased knowledge at immediate (SMD = -0.51 [95% CI: -0.72, -0.31]), short (SMD = -0.48 [95% CI: -0.90, -0.05]), and long-term (RR = 1.28 [95% CI: 1.10, 1.49]) and pain self-efficacy at short (SMD = -0.78 [95% CI: -0.98, -0.58]) and long-term (SMD = -0.32 [95% CI: -0.52, -0.12]). We found moderate to very low-quality evidence that PEMs reduced short-term days off work (SMD = -0.35 [95% CI: -0.63, -0.08]), long-term imaging referrals (RR = 0.60 [95% CI: 0.41, 0.89]), and long-term physician visits (SMD = -0.16 [95% CI: -0.26, -0.05]). Compared to other interventions (e.g., yoga, Pilates), PEMs had no effect or were less effective for acute/subacute and chronic LBP. CONCLUSIONS There was a high degree of variability across outcomes and time points, but providing PEMs appears favorable to usual care as we observed many small, positive patient and system impacts for acute/subacute and chronic LBP. PEMs were generally less effective than other interventions; however, no cost effectiveness analyses were performed to weigh the relative benefits of these interventions to the likely less costly PEMs.
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Affiliation(s)
- Bradley Furlong
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Holly Etchegary
- Clinical Epidemiology, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Michelle Swab
- Health Sciences Library, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Andrea Pike
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
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"Myths and Facts" Education Is Comparable to "Facts Only" for Recall of Back Pain Information but May Improve Fear-Avoidance Beliefs: An Embedded Randomized Trial. J Orthop Sports Phys Ther 2022; 52:586-594. [PMID: 35802818 DOI: 10.2519/jospt.2022.10989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the effectiveness of patient education with "myths and facts" versus "facts only" on recall of back pain information and fear-avoidance beliefs in patients with chronic low back pain (LBP). DESIGN Randomized Study Within A Trial. METHODS One hundred fifty-two participants with chronic LBP were included. Participants allocated to the "facts only" group received an information sheet with 6 LBP facts, whereas those allocated to the "myths and facts" group received the same information sheet, with each myth refuted by its respective fact. The primary outcome was a correct recall of back pain facts, and the secondary outcome was the physical activity component of the Fear-Avoidance Beliefs Questionnaire (FABQ-PA), 2 weeks after the provision of the information sheet. RESULTS There was no evidence of a difference in the proportion of participants with a correct recall between the "myths and facts" and "facts only" groups (odds ratio = 0.98; 95% confidence interval [CI]: 0.48, 1.99) and no significant difference in FABQ-PA mean scores between groups (-1.58; 95% CI: -3.77, 0.61). Sensitivity analyses adjusted for prognostic factors showed no difference in information recall but a larger difference in FABQ-PA scores (-2.3; 95% CI: -4.56, -0.04). CONCLUSION We found no overall difference in the recall of back pain information for patients provided with "myths and facts" compared with that for patients provided with "facts only" and a slight reduction in fear-avoidance beliefs for physical activity using "myths and facts" compared with that using "facts only," but the meaningfulness of this result is uncertain. J Orthop Sports Phys Ther 2022;52(9):586-594. Epub: 9 July 2022. doi:10.2519/jospt.2022.10989.
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Digital rehabilitation for hand and wrist pain: a single-arm prospective longitudinal cohort study. Pain Rep 2022; 7:e1026. [PMID: 36003064 PMCID: PMC9394689 DOI: 10.1097/pr9.0000000000001026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/10/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. This study supports that a fully remote digital care program is feasible and able to promote high patient engagement in the telerehabilitation of patients with wrist and hand pain. Introduction: Wrist and hand represent the third most common body part in work-related injuries, being associated with long-term absenteeism. Telerehabilitation can promote access to treatment, patient adherence, and engagement, while reducing health care–related costs. Objective: Report the results of a fully remote digital care program (DCP) for wrist and hand pain (WP). Methods: A single-arm interventional study was conducted on individuals with WP applying for a DCP. Primary outcome was the mean change in the Numerical Pain Rating Scale after 8 weeks (considering a minimum clinically important change of 30%). Secondary outcomes were: disability (Quick Disabilities of the Arm, Shoulder, and Hand questionnaire), analgesic intake, surgery intention, mental health (patient health questionnaire [PHQ-9] and generalized anxiety disorder [GAD-7]), fear-avoidance beliefs (FABQ-PA), work productivity and activity impairment, and engagement. Results: From 189 individuals starting the DCP, 149 (78.8%) completed the intervention. A significant pain improvement was observed (51.3% reduction (2.26, 95% CI 1.73; 2.78)) and 70.4% of participants surpassing minimum clinically important change. This change correlated with improvements in disability (52.1%), FABQ-PA (32.2%), and activities impairment recovery (65.4%). Improvements were also observed in other domains: surgery intent (76.1%), mental health (67.0% in anxiety and 72.7% in depression), and overall productivity losses (68.2%). Analgesic intake decreased from 22.5% to 7.1%. Mean patient satisfaction score was 8.5/10.0 (SD 1.8). Conclusions: These findings support the feasibility and utility of a fully remote DCP for patients with WP. Clinically significant improvements were observed in all health-related and productivity-related outcomes, alongside very high patient adherence rates and satisfaction. This study strengthens that management of WP is possible through a remote DCP, decreasing access barriers and potentially easing health care expenditure.
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Aguilar-Ferrándiz ME, Matarán-Peñarrocha GA, Tapia-Haro RM, Castellote-Caballero Y, Martí-García C, Castro-Sánchez AM. Effects of a supervised exercise program in addition to electrical stimulation or kinesio taping in low back pain: a randomized controlled trial. Sci Rep 2022; 12:11430. [PMID: 35794120 PMCID: PMC9259681 DOI: 10.1038/s41598-022-14154-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/02/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractChronic low back pain it is one of the most common health problems worldwide. Usually is accompanied by a complex set of symptoms and generates significant direct and indirect socioeconomic and health costs. From a therapeutic point of view, there are a wide variety of methods to address the treatment of this pathology, however, these therapies have not been shown definitive efficacy. To investigate the effect of a mixed treatment with exercise and electrical stimulation versus exercise and kinesio taping in patients with non-specific chronic low back pain. A total of 58 patients participated in this single-blinded randomised clinical trial. Participants were assigned to the exercises- kinesio taping group, or exercises- analgesic current group, both received 12 treatment sessions. Disability, fear of movement, anxiety, depression, sleeps quality, pain, lower limb mechanosensitivity and pressure-pain thresholds were recorded at baseline and after 4 weeks of treatment. The 2 × 2 mixed analysis of covariance test showed statistically significant differences between groups for pain (P = 0.046). Pair-wise comparisons with baseline demonstrated significant differences for both groups in pain (P ≤ 0.001), disability (P ≤ 0.001), pressure-pain thresholds (P ≤ 0.044), lower limb mechanosensitivity, (P ≤ 0.047), anxiety (P ≤ 0.001), depression (P ≤ 0.001) and sleep quality (P ≤ 0.010). Patients with chronic low back pain who received a combined treatment of exercises and kinesio taping or analgesic current showed an improvement in pain, disability, anxiety, depression and sleep pattern. Moreover, exercises combined with electrotherapy produces greater improvements over these variables.Trial registration: NCT02812459.
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Chancel R, Miot S, Dellapiazza F, Baghdadli A. Group-based educational interventions in adolescents and young adults with ASD without ID: a systematic review focusing on the transition to adulthood. Eur Child Adolesc Psychiatry 2022; 31:1-21. [PMID: 32889578 DOI: 10.1007/s00787-020-01609-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
There is a growing number of young people, diagnosed with an autism-spectrum disorder (ASD), transitioning to adulthood. Among this number, individuals without an intellectual disability have significant adaptive deficits and need individualized care and support services to better target vocational, social, and educational prospects and outcomes. Group-based interventions, including patient education, social-skills training, and cognitive-behavioral therapy, are widely used in clinical settings to improve the daily life and prospects of ASD individuals facing the challenge of transitioning to adulthood. We performed a systematic review of studies concerning the efficiency of group-based educational interventions with a focus on the transition to adulthood for young, ASD individuals without intellectual disability (ID). As a result of this systematic search, 21 studies out of 163 were found to be eligible for inclusion. We observed considerable heterogeneity across the studies, in terms of effect sizes and intervention design, delivery, and the comparison of controls. Strong evidence was found in favor of social-skills training and cognitive-behavioral therapy interventions. Professionals should consider group-based psychoeducational intervention to be an appropriate and relevant service for young subjects with ASD without ID transitioning to adulthood. Further research is needed on larger samples using multicentric designs to validate efficacy before generalization.
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Affiliation(s)
- Raphael Chancel
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France.,Faculté de Médecine, Université de Montpellier, Montpellier, France
| | - Stephanie Miot
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.,Gerontology Centre, Antonin Balmès, University Hospital of Montpellier, CHU de Montpellier, Université de Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier, France
| | - Florine Dellapiazza
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France. .,Faculté de Médecine, Université de Montpellier, Montpellier, France. .,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
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16
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Individual Patient Education for Managing Acute and/or Subacute Low Back Pain: Little Additional Benefit for Pain and Function Compared to Placebo. A Systematic Review With Meta-analysis of Randomized Controlled Trials. J Orthop Sports Phys Ther 2022; 52:432-445. [PMID: 35584025 DOI: 10.2519/jospt.2022.10698] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effects of individual patient education for managing acute and/or subacute low back pain (LBP), compared to no intervention/placebo education, noneducational interventions, or other type of education. DESIGN Systematic review with meta-analysis of randomized trials. LITERATURE SEARCH PubMed, CINAHL, PEDro, Embase, Scopus, and CENTRAL (up to September 30, 2020); reference lists of previous systematic reviews. STUDY SELECTION CRITERIA Randomized controlled trials (RCTs) evaluating individual education for patients with acute and/or subacute LBP. DATA SYNTHESIS Random-effects meta-analysis for clinically homogeneous RCTs. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS We included 13 RCTs. There was moderate certainty evidence that individual patient education was more effective than placebo education for pain at medium term (mean difference [MD], -0.79; 95% confidence interval [CI]: -1.52, -0.07) and physical function at short term (standardized mean difference [SMD], -0.25; 95% CI: -0.47, -0.02) and medium term (SMD, -0.26; 95% CI: -0.48, -0.04), but with no clinically relevant effects. There was low-to-moderate certainty evidence that individual patient education was superior to noneducational interventions on short-term quality of life (MD, -12.00; 95% CI: -20.05, -3.95) and medium-term sick leave (odds ratio = 0.32; 95% CI: 0.11, 0.88). We found no clinically relevant between-group effects for any other comparison (low-to-high certainty of evidence) at any follow-up. CONCLUSION One or 2 hours of individual patient education probably makes little to no difference in pain and functional outcomes compared with placebo for patients with acute and/or subacute LBP. Considering its effects on other outcomes (eg, reassurance) and patients' desire for information about their condition, it is reasonable to retain patient education as part of a first-line approach when managing acute and subacute LBP. J Orthop Sports Phys Ther 2022;52(7):432-445. Epub: 18 May 2022. doi:10.2519/jospt.2022.10698.
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Alsiaf H, O'Neill TW, Callaghan MJ, Goodwin PC. Physical therapy of patients undergoing first-time lumbar discectomy: a survey of current UK practice. BMC Musculoskelet Disord 2022; 23:503. [PMID: 35624458 PMCID: PMC9137089 DOI: 10.1186/s12891-022-05346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The type, timing, and extent of provision of rehabilitation for lumbar discectomy patients in the UK are currently unknown. The aim of this study was to determine the provision and type of rehabilitation for patients undergoing lumbar discectomy in UK neurosurgical centers. METHOD Physical therapists involved in treating lumbar discectomy patients in UK neurosurgery centers were invited to complete an online survey that asked about the type, timing (preop, postop), and rehabilitation content for patients undergoing lumbar discectomy. RESULTS Seventeen UK neurosurgery centers completed the survey. Twelve (36%) responded from the 33 centers targeted as well as an additional five private centers. All participating centers provided a rehabilitation service for lumbar discectomy patients. Rehabilitation was provided preoperatively in n = 6 (35%) centers, postoperatively as an inpatient in all centers, and postoperatively as an outpatient in n = 14 (82%) centers. Factors that influenced the decision to provide rehabilitation included both external and internal or patient-related factors. Preoperative rehabilitation focused mainly on education, whilst postoperative outpatient rehabilitation focused more on exercises. Rehabilitation consistently included mobility, functional task training, and exercise prescription. CONCLUSIONS Whilst all neurosurgical centers in this survey provided some form of rehabilitation for patients undergoing LD surgery, the approach remains inconsistent. Rehabilitation was delivered most frequently postoperatively, with one in three centers providing it preoperatively. Rehabilitation content also varied depending on when it was provided. Further research is needed to determine the optimum timing, contents, and target of rehabilitation for patients undergoing LD surgery.
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Affiliation(s)
- Hanan Alsiaf
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. .,Department of Physiotherapy, King Fahad Military Medical Complex - KFMMC, Dhahran, Kingdom of Saudi Arabia.
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Department of Rheumatology, Salford Royal, NHS Foundation Trust, Salford, UK
| | - Michael J Callaghan
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Department of health Professions, Manchester Metropolitan University, Manchester, UK.,Medical, Manchester United Ltd, Manchester, UK
| | - Peter C Goodwin
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Department of health Professions, Manchester Metropolitan University, Manchester, UK
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Wu Z, Zhu Y, Wang Y, Zhou R, Ye X, Chen Z, Li C, Li J, Ye Z, Wang Z, Liu W, Xu X. The Effects of Patient Education on Psychological Status and Clinical Outcomes in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:848427. [PMID: 35370836 PMCID: PMC8968629 DOI: 10.3389/fpsyt.2022.848427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/10/2022] [Indexed: 12/25/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is a common systemic inflammatory autoimmune disease. The disease has a serious impact on mental health and requires more effective non-pharmacological interventions. Objective This study aims to systematically evaluate the effectiveness of patient education on psychological status and clinical outcomes in rheumatoid arthritis. Methods This systematic review and meta-analysis was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane Library, EMBASE database, and Web of Science database were screened for articles published until November 2, 2021. Randomized controlled trials (RCTs) of patient education for RA were included. Outcomes measures included pain, physical function, disease activity, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anxiety, depression, Arthritis Self-Efficacy (pain, other symptoms, total), and General health. For each outcome, standardized mean differences or mean differences and 95% confidence intervals (CIs) were calculated. Results A total of 24 RCTs (n = 2,276) were included according to the inclusion and exclusion criteria. Meta-analysis revealed a statistically significant overall effect in favor of patient education for physical function [SMD = -0.52, 95% CI (-0.96, -0.08), I 2 = 93%, P = 0.02], disease activity [SMD = -1.97, 95% CI (-3.24, -0.71), I 2 = 97%, P = 0.002], ASE (pain) [SMD = -1.24, 95% CI (-2.05, -0.43), I 2 = 95%, P = 0.003], ASE (other symptoms) [SMD = -0.25, 95% CI (-0.41, -0.09), I 2 = 25%, P = 0.002], ASE (total) [SMD = -0.67, 95% CI (-1.30, -0.05), I 2 = 90%, P = 0.03], and general health [SMD = -1.11, 95% CI (-1.36, -0.86), I 2 = 96%, P < 0.00001]. No effects were found for anxiety [SMD = 0.17, 95% CI (-0.64, 0.98), I 2 = 82%, P = 0.68], depression [SMD = -0.18, 95% CI (-0.52, 0.15), I 2 = 52%, P = 0.28], pain [SMD = -0.37, 95% CI (-0.80, 0.05), I 2 = 89%, P = 0.08], and CRP [SMD = -0.27, 95% CI (-0.57, 0.02), I 2 = 0%, P = 0.07]. Conclusions Patient education may be effective in improving clinical outcomes and psychological status in patients with rheumatoid arthritis. Considering the methodological limitations of the included RCTs, more high-quality and large-sample RCTs are needed to confirm this conclusion in the future. Systematic Review Registration http://www.crd.york.ac.uk/prospero, identifier: CRD42021250607.
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Affiliation(s)
- Zugui Wu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yue Zhu
- Baishui Health Center, Qujing, China
| | - Yi Wang
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rui Zhou
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangling Ye
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zehua Chen
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Congcong Li
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junyi Li
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zixuan Ye
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhenbang Wang
- Qujing Hospital of Traditional Chinese Medicine, Qujing, China
| | - Wengang Liu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Xuemeng Xu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
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Sitges C, Terrasa JL, García-Dopico N, Segur-Ferrer J, Velasco-Roldán O, Crespí-Palmer J, González-Roldán AM, Montoya P. An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial. JMIR Mhealth Uhealth 2022; 10:e29171. [PMID: 35289758 PMCID: PMC8965676 DOI: 10.2196/29171] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/28/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Concomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions.
Objective
The aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality.
Methods
A 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46%; mean age 45.00, SD 9.13 years; 10/23, 43% men) or a face-to-face group (27/50, 54%; mean age 48.63, SD 7.54 years; 7/27, 26% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times).
Results
After the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; P<.001), helplessness (6.38 vs 4.74; P=.02), fear-avoidance beliefs (35 vs 29.11; P=.03), and avoidance of physical activity (12.07 vs 9.28; P=.01) scores, but there was an increase in the disability score (6.08 vs 7.5; P=.01). No significant differences between the groups or sessions were found in heart rate variability resting-state data, electroencephalographic data from the Eriksen flanker task, PPTs, subjective ratings, or cognitive performance.
Conclusions
Both intervention modalities increased mainly beta activity at rest and improved psychological functioning. Given the limitations of our study, conclusions must be drawn carefully and further research will be needed. Nevertheless, to the best of our knowledge, this is the first study reporting electroencephalographic changes in patients with CLBP after an mHealth intervention.
Trial Registration
ClinicalTrials.gov NCT04576611; https://clinicaltrials.gov/ct2/show/NCT04576611
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Affiliation(s)
- Carolina Sitges
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Juan L Terrasa
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Nuria García-Dopico
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain
| | - Joan Segur-Ferrer
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Olga Velasco-Roldán
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain
| | - Jaume Crespí-Palmer
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Ana María González-Roldán
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Pedro Montoya
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
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20
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Physiotherapy combined with therapeutic neuroscience education versus physiotherapy alone for patients with chronic low back pain: A pilot, randomized-controlled trial. Turk J Phys Med Rehabil 2021; 67:283-290. [PMID: 34870114 PMCID: PMC8606998 DOI: 10.5606/tftrd.2021.5556] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/25/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives
The aim of this study was to investigate the effect of therapeutic neuroscience education (TNE) combined with physiotherapy on pain, kinesiophobia, endurance, and disability in chronic low back pain (CLBP) patients.
Patients and methods
Between November 2016 and December 2017, a total of 31 patients with CLBP (5 males, 26 females; mean age: 42.3±10.8 years; range, 20 to 58 years) were randomly allocated to receive physiotherapy combined with TNE (experimental group, EG, n=16) and physiotherapy alone (control group, CG, n=15). All participants received physiotherapy consisting of five sessions per week for a total of three weeks. In addition to physiotherapy, the EG received TNE sessions consisting of two sessions per week for a total of three weeks. The primary outcomes were pain intensity as assessed by Visual Analog Scale (VAS) and kinesiophobia by Tampa Scale for Kinesiophobia (TSK), while and the secondary outcomes were trunk muscle endurance as assessed by the partial curl-up test (trunk flexor endurance [TFE]) and modified Sorensen test (trunk extensor endurance [TEE]) and disability by Roland-Morris Disability Questionnaire (RMDQ).
Results
All patients completed the study. The median VAS, TSK, TFE, TEE, and RMDQ scores for the EG significantly improved after three weeks, while there was only significant improvement in the VAS, TSK, and RMDQ scores in the CG. The TSK decreased more in the EG than in the CG. The significant difference was evident in TSK and TFE in favor of the EG (p<0.05).
Conclusion
These results suggest that the combination of TNE with physiotherapy can improve kinesiophobia and trunk flexor muscle endurance of patients with CLBP in the short-term.
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21
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Wertli MM, Flury JS, Streit S, Limacher A, Schuler V, Ferrante AN, Rimensberger C, Haschke M. Efficacy of metamizole versus ibuprofen and a short educational intervention versus standard care in acute and subacute low back pain: a study protocol of a randomised, multicentre, factorial trial (EMISI trial). BMJ Open 2021; 11:e048531. [PMID: 34645660 PMCID: PMC8515449 DOI: 10.1136/bmjopen-2020-048531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Low back pain (LBP) is among the top three most common diseases worldwide, resulting in a life with pain-related disability. To date, no study has assessed the efficacy of metamizole (dipyrone), a non-opioid analgesic and antipyretic prodrug compared with the conventional non-steroidal anti-inflammatory drug ibuprofen, in patients with an acute LBP episode. Further, it is unclear, whether a short educational intervention is superior to usual care alone. OBJECTIVES The objective of this study is to assess first, whether metamizole is non-inferior to ibuprofen in a new episode of acute or subacute LBP. Second, we aim to assess whether a short educational intervention including evidence-based patient information on the nature of LBP is superior to usual care alone. METHODS AND ANALYSIS An investigator-initiated multicentre, randomised, double blind trial using a factorial design will be performed. A total of 120 participants with a new episode of LBP will be recruited from GP practices, outpatient clinics and from emergency departments, and randomised into four different treatment groups: ibuprofen alone, ibuprofen and short intervention, metamizole alone, metamizole and short intervention. The primary endpoint for the medical treatment will be change in pain assessed on an 11-point Numeric Rating Scale after 14 days. The primary outcome for the short intervention will be change in the Core Outcome Measures Index assessed after 42 days. ETHICS, DISSEMINATION AND FUNDING This study has been approved by the responsible Ethics Board (Ethikkommission Bern/2018-01986) and the Swiss Agency for Therapeutic Products (Swissmedic/2019DR4002). Results will be published in open access policy peer-reviewed journals. The study is funded by the Swiss National Science Foundation (grant number 32 003B-179346). TRIAL REGISTRATION NUMBER NCT04111315.
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Affiliation(s)
- Maria M Wertli
- Department of General Internal Medicine, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Julian S Flury
- Department of General Internal Medicine, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Vanessa Schuler
- Department of General Internal Medicine, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Asha-Naima Ferrante
- Department of General Internal Medicine, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Caroline Rimensberger
- Department of General Internal Medicine, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Manuel Haschke
- Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
- Department of Clinical Pharmacology and Toxicology, University of Bern, Bern, Switzerland
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22
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See QY, Tan JNB, Kumar DS. Acute low back pain: diagnosis and management. Singapore Med J 2021; 62:271-275. [PMID: 34409471 DOI: 10.11622/smedj.2021086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Qin Yong See
- Care and Health Integration, Changi General Hospital, Singapore
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23
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Keen S, Lomeli-Rodriguez M, Williams ACDC. Exploring how people with chronic pain understand their pain: a qualitative study. Scand J Pain 2021; 21:743-753. [PMID: 34331751 DOI: 10.1515/sjpain-2021-0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A fundamental principle of pain management is educating patients on their pain using current neuroscience. However, current pain neurophysiology education (PNE) interventions show variable success in improving pain outcomes, and may be difficult to integrate with existing understanding of pain. This study aimed to investigate how people with chronic pain understand their pain, using qualitative exploration of their conceptualisations of pain, and how this understanding accommodated, or resisted, the messages of PNE. METHODS Twelve UK adults with chronic pain were recruited through advertisements on online pain networks. Semi-structured interviews were conducted remotely, with responses elicited using the Grid Elaboration Method (GEM) and then a PNE article. Participants' grid elaborations and responses to PNE were analysed using thematic analysis (TA). RESULTS Three main themes were extracted from participants' grid elaborations: communicating pain, explaining pain and living with pain. These themes incorporated varied, inconsistent sub-themes: of pain as simultaneously experiential and conceptual; in the body and in the mind; diagnosable and inexplicable; manageable and insuperable. Generalised, meta-level agreement was identified in participants' PNE responses, but with doubts about its practical value. CONCLUSIONS This study shows that people understand pain through inconsistent experiential models that may resist attempts at conceptual integration. Participants' elaborations showed diverse and dissonant conceptualisations, with experiential themes of restricted living; assault on the self; pursuit of understanding pain and abandonment of that pursuit. Responses, although unexpectedly compatible with PNE, suggested that PNE was perceived as intellectually engaging but practically inadequate. Experiential disconfirmation may be required for behavioural change inhibited by embedded fears and aversive experiences. ETHICAL COMMITTEE NUMBER UCL REC# 17833/003.
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Affiliation(s)
- Sam Keen
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Martha Lomeli-Rodriguez
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
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24
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Effects of the Multidimensional Treatment on Pain, Disability, and Sitting Posture in Patients with Low Back Pain: A Randomized Controlled Trial. Pain Res Manag 2021; 2021:5581491. [PMID: 34306274 PMCID: PMC8263210 DOI: 10.1155/2021/5581491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/21/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to investigate the effects of multidimensional approach model on the pain, disability, and sitting posture in patients with nonspecific low back pain (LBP). Sixty LBP patients were recruited and were randomly divided into two groups: multidimensional treatment (MT) group (n = 30) and unimodal treatment (UT) group (n = 30). All participants underwent 48 sessions of treatment (40 min/session, two sessions per day, 2 days per week) for 12 weeks. The MT group conducted a core stability exercise twice a day and additionally provided training on pain principles and management methods. The UT group only performed a core stability exercise twice a day. The visual analog scale (VAS) and Oswestry Disability index (ODI) were used to measure pain intensity and disability. Thoracolumbar kyphosis and lumbar lordosis in the sitting position were measured using a motion capture system. After training, the pain and disability in the MT group improved significantly greater than the UT group (p < 0.05). In the MT group, the pain relief effect persisted 3 months after the end of training. Thoracolumbar kyphosis and lumbar lordosis in the MT group were significantly improved compared to the UT group (p < 0.05). Thus, MT combined with core stability exercise may be used to improve the pain, disability, and sitting posture in patients with LBP.
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25
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Ogwumike OO, Bashir-Bello F, Kaka B. Patients' Experiences About Exercise Prescription and Education in the Physiotherapy Management of Nonspecific Low-Back Pain. J Patient Exp 2021; 7:1458-1465. [PMID: 33457602 PMCID: PMC7786732 DOI: 10.1177/2374373520968997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Low-back pain (LBP) is highly prevalent in the society, and its socioeconomic consequences are quite evident. Physiotherapists play a prominent role in the management of individuals with this condition, and it is, therefore, of utmost importance that physiotherapists engage in the most efficient and effective management practices available. For perceptions of good performance and quality health care, patient experience is an important indicator of effective care and management. A mixed-methods research design—a cross-sectional survey (quantitative research) and a focus group discussion (FGD; qualitative research)—was employed in this study, investigating patients’ experience in physiotherapy management of nonspecific LBP. An adapted questionnaire was used for data collection from purposively selected participants recruited from 3 hospitals in Kubwa, Abuja, from April to August 2018. The FGD involved 6 patients recruited by simple random sampling using the fishbowl technique. Descriptive and thematic analyses were done on data collected. A total of 126 patients (male = 41, female = 85) were included, with a mean age of 51.0 ± 14.6 years, while the modal age-group was 60 to 69 years. Of these, 41 (32.5%) had nonspecific LBP for less than a year, and the 2 most applied interventions were exercise and heat therapy, followed by education/advice. In all, 110 (87.3%) reported positive experience about education, while 119 (94.4%) reported positive experience about exercise prescription. The result from the qualitative research is in conformity with that of the quantitative analysis. Patients with nonspecific LBP received adequate education regarding their condition and had good experience in the course of their physiotherapy management.
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Affiliation(s)
- Omoyemi O Ogwumike
- Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria.,Department of Physiotherapy, University College Hospital, Ibadan, Nigeria
| | - Fatima Bashir-Bello
- Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria
| | - Bashir Kaka
- Department of Physiotherapy, College of Health Sciences, Bayero University, Kano, Nigeria
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26
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Furlong B, Aubrey-Bassler K, Etchegary H, Pike A, Darmonkow G, Swab M, Hall A. Patient education materials for non-specific low back pain and sciatica: a protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e039530. [PMID: 32878763 PMCID: PMC7470487 DOI: 10.1136/bmjopen-2020-039530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Low back pain accounts for more disability than any other musculoskeletal condition and is associated with severe economic burden. Patients commonly present with negative beliefs about low back pain and this can have detrimental effects on their health outcomes. Providing evidence-based, patient-centred education that meets patient needs could help address these negative beliefs and alleviate the substantial low back pain burden. The primary aim of this review is to investigate the effectiveness of patient education materials on immediate process, clinical and health system outcomes. METHODS AND ANALYSIS The search strategy was developed in collaboration with a librarian and systematic searches will be performed in MEDLINE, EMBASE, CINAHL, PsycINFO and SPORTDiscus. We will also search trial registries and grey literature through the OpenGrey database. Study selection will include a title and abstract scan and full-text review by two authors. Only randomised controlled trials will be included in this review. Trials must include patients with low back pain or sciatica and investigate educational interventions with at least one of the following contrasts: (1) education alone versus no intervention; (2) education alone versus another intervention; (3) education in addition to another intervention versus the same intervention with no education. Data extraction, risk of bias and grading of the quality of evidence will be performed independently by two reviewers. Risk of bias will be assessed using the PEDro scale, and the quality of evidence will be assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach. A random-effects model will be used for each contrast, and results will be pooled if the participants, interventions, and outcomes are homogeneous. If heterogeneity is high (I2 >75%), we will evaluate the magnitude and direction of the differences in effect sizes across studies to determine if it remains reasonable to pool the results. Analyses of acute and subacute low back pain (less than 12 weeks duration) will be performed separately from chronic low back pain (12 weeks or greater duration). Likewise, analyses of short-term (less than 6 months) and long-term (6 months or greater) follow-up will be performed separately. Subgroup analyses will be performed on non-specific low back pain, sciatica and mixed populations. ETHICS AND DISSEMINATION Ethical approval is not required for this review. This study, along with its results, will be published in a peer-reviewed journal.
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Affiliation(s)
- Bradley Furlong
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Holly Etchegary
- Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Andrea Pike
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Georgia Darmonkow
- Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Michelle Swab
- Health Sciences Library, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland, Canada
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Baker P, Coole C, Drummond A, Khan S, McDaid C, Hewitt C, Kottam L, Ronaldson S, Coleman E, McDonald DA, Nouri F, Narayanasamy M, McNamara I, Fitch J, Thomson L, Richardson G, Rangan A. Occupational advice to help people return to work following lower limb arthroplasty: the OPAL intervention mapping study. Health Technol Assess 2020; 24:1-408. [PMID: 32930659 PMCID: PMC7520717 DOI: 10.3310/hta24450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hip and knee replacements are regularly carried out for patients who work. There is little evidence about these patients' needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively. OBJECTIVES To develop an occupational advice intervention to support early recovery to usual activities including work that is tailored to the requirements of patients undergoing hip or knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks. DESIGN An intervention mapping approach was used to develop the intervention. The research methods employed were rapid evidence synthesis, qualitative interviews with patients and stakeholders, a prospective cohort study, a survey of clinical practice and a modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the intervention mapping process. SETTING Orthopaedic departments in NHS secondary care. PARTICIPANTS Patients who were in work and intending to return to work following primary elective hip or knee replacement surgery, health-care professionals and employers. INTERVENTIONS Occupational advice intervention. MAIN OUTCOME MEASURES Development of an occupational advice intervention, fidelity of the developed intervention when delivered in a clinical setting, patient and clinician perspectives of the intervention and preliminary assessments of intervention effectiveness and cost. RESULTS A cohort study (154 patients), 110 stakeholder interviews, a survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, a personalised return-to-work plan and co-ordination from the health-care team to support the delivery of 13 patient and 20 staff performance objectives. To support delivery, a range of tools (e.g. occupational checklists, patient workbooks and employer information), roles (e.g. return-to-work co-ordinator) and training resources were created. Feasibility was assessed for 21 of the 26 patients recruited from three NHS trusts. Adherence to the defined performance objectives was 75% for patient performance objectives and 74% for staff performance objectives. The intervention was generally well received, although the short time frame available for implementation and concurrent research evaluation led to some confusion among patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff. LIMITATIONS Implementation and uptake of the intervention was not standardised and was limited by the study time frame. Evaluation of the intervention involved a small number of patients, which limited the ability to assess it. CONCLUSIONS The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention. FUTURE WORK The intervention warrants a randomised controlled trial to assess its clinical effectiveness and cost-effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure that adoption is sustained. STUDY REGISTRATION Current Controlled Trials ISRCTN27426982 and PROSPERO CRD42016045235. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 45. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Baker
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Carol Coole
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sayeed Khan
- Make UK, The Manufacturers' Organisation, London, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lucksy Kottam
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David A McDonald
- Whole System Patient Flow Programme, Scottish Government, Edinburgh, UK
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Nouri
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Melanie Narayanasamy
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Iain McNamara
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Judith Fitch
- British Orthopaedic Association Patient Liaison Group, Royal College of Surgeons of England, London, UK
| | - Louise Thomson
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Amar Rangan
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- Faculty of Medical Sciences, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Community Pharmacist's Role in Detecting Low Back Pain, and Patient Attitudes-A Cross-Sectional Observational Study in Italian Community Pharmacies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165965. [PMID: 32824541 PMCID: PMC7460157 DOI: 10.3390/ijerph17165965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Low back pain (LBP) is one of the most frequent diseases for which patients seek advice in a community pharmacy. The study aimed to evaluate the feasibility of the administration by community pharmacists of questionnaires to assess the LBP intensity and disability degree in patients entering community pharmacies and the attitudes they have toward pain management by pharmacological and non-pharmacological strategies. METHODS An explorative, cross-sectional, observational, and quantitative study was performed. Twelve Italian community pharmacists were asked to submit a questionnaire on LBP to patients visiting their pharmacies. The questionnaire included a pain intensity scale, and two validated tools: the Roland and Morris Disability Questionnaire (RMDQ) and the Start Back Screening Tool (SBST) to determine the degree and risk of patient disability, respectively. RESULTS 872 patients filled out the questionnaires in 6 months. No statistical differences between genders (p > 0.30) were recorded for pain intensity (Female: median score 6, IQR 4-7; Male: median scores 5, IQR 4-7; p > 0.30) and disability associated with LBP (RMDQ high-disability level: Females, 14.7%, Males, 15.0%; p > 0.90). Most of the patients (69%) reported a low degree of disability, but the risk of disability was medium and high in 36% and 18% of them, respectively (p < 0.05). About 14% of patients declare to never seek for physician's advice despite their medium-high degree of disability. CONCLUSION The study demonstrated the feasibility of validated tools for assessing the degree and risk of disability in LBP patients administrable in community pharmacies. Moreover, the community pharmacy resulted in an important care portal for patients suffering from moderate LBP and for intercepting patients who suffered from severe LBP but had never reported their problem to their physician.
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Karlsson M, Bergenheim A, Larsson MEH, Nordeman L, van Tulder M, Bernhardsson S. Effects of exercise therapy in patients with acute low back pain: a systematic review of systematic reviews. Syst Rev 2020; 9:182. [PMID: 32795336 PMCID: PMC7427286 DOI: 10.1186/s13643-020-01412-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 06/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute low back pain is associated with pain and disability, but symptoms are often self-healing. The effectiveness of exercise therapy for acute low back pain remains uncertain with conflicting evidence from systematic reviews. The aim of this systematic review of systematic reviews was to assess the overall certainty of evidence for the effects of exercise therapy, compared with other interventions, on pain, disability, recurrence, and adverse effects in adult patients with acute low back pain. METHODS PubMed, the Cochrane library, CINAHL, PEDro, Open Grey, Web of Science, and PROSPERO were searched for systematic reviews of randomized controlled trials. Methodological quality was assessed independently by two authors using AMSTAR. Meta-analyses were performed if possible, using data from the original studies. Data for pain, disability, recurrence, and adverse effects were analyzed. Certainty of evidence was assessed using GRADE. RESULTS The searches retrieved 2602 records, of which 134 publications were selected for full-text screening. Twenty-four reviews were included, in which 21 randomized controlled trials (n = 2685) presented data for an acute population, related to 69 comparisons. Overlap was high, 76%, with a corrected covered area of 0.14. Methodological quality varied from low to high. Exercise therapy was categorized into general exercise therapy, stabilization exercise, and McKenzie therapy. No important difference in pain or disability was evident when exercise therapy was compared with sham ultrasound, nor for the comparators usual care, spinal manipulative therapy, advice to stay active, and educational booklet. Neither McKenzie therapy nor stabilization exercise yielded any important difference in effects compared with other types of exercise therapy. Certainty of evidence varied from very low to moderate. CONCLUSIONS The findings suggest very low to moderate certainty of evidence that exercise therapy may result in little or no important difference in pain or disability, compared with other interventions, in adult patients with acute low back pain. A limitation of this systematic review is that some included reviews were of low quality. When implementing findings of this systematic review in clinical practice, patients' preferences and the clinician's expertise also should be considered, to determine if and when exercise therapy should be the intervention of choice. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD46146, available at: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=46146 .
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Affiliation(s)
- Marc Karlsson
- Region Skåne, Healthcare Centre Oxie, Malmö, Sweden.,Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Anna Bergenheim
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Uddevalla Rehabilitation, Uddevalla, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, 6th floor, SE-412 19, Gothenburg, Sweden
| | - Maria E H Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, 6th floor, SE-412 19, Gothenburg, Sweden
| | - Lena Nordeman
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, 6th floor, SE-412 19, Gothenburg, Sweden
| | - Maurits van Tulder
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department Physiotherapy & Occupational Therapy, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Susanne Bernhardsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden. .,Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, 6th floor, SE-412 19, Gothenburg, Sweden.
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Ghai B, Gudala K, Asrar MM, Chanana N, Kanukula R, Bansal D. Development, validation and evaluation of a novel self-instructional module in patients with chronic non-specific low back pain. Indian J Anaesth 2020; 64:299-305. [PMID: 32489204 PMCID: PMC7259409 DOI: 10.4103/ija.ija_779_19] [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: 11/17/2019] [Revised: 01/08/2020] [Accepted: 03/04/2020] [Indexed: 11/04/2022] Open
Abstract
Background Low back pain (LBP) is ranked highest in terms of disability-adjusted life-years lived. Patient education and self-management have shown to play a crucial role in the overall pain management. However, the literature on the same with respect to Indian context is still lacking. The study was aimed to develop, validate and assess the acceptability and effectiveness of self-instructional educational module among Indian chronic LBP (CLBP) patients. Methods A prospective single-arm open-label study was conducted in a pain clinic of a tertiary care public hospital in North India with 'Backcare booklet-self-instructional module (SIM)' as an intervention in patients with CLBP. SIM was developed with the intent to provide up-to-date evidence-based information in an easy understanding way to patients with CLBP. 132 patients were administered SIM with a single session of verbal explanation. Pain intensity (numeric rating scale [NRS]), disability, fear-avoidance belief Questionnaire (FABQ), quality of life (EQ5D) and knowledge level were assessed at baseline and after 3 months of intervention. Student's paired t-test and Chi-square test were used. Data were analysed using SPSS version 15.0. Results 120 patients successfully completed the 3 months' follow-up. Significant reductions were observed in pain intensity (76[12] vs 55 [15, P < 0.01); disability (51[14] vs 43 [10], P < 0.01); FABQ (46[12] vs 41 [10], P < 0.01); EQ5D (0.35 [0.27] vs 0.18 [0.26], P < 0.01). Conclusion Backcare booklet as an intervention, along with usual pharmacological care is a cost-effective educational medium to promote self-management of CLBP in the clinical outpatient settings.
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Affiliation(s)
- Babita Ghai
- Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kapil Gudala
- Clinical Research Unit, Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
| | - Mir M Asrar
- Clinical Research Unit, Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
| | - Neha Chanana
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raju Kanukula
- Clinical Research Unit, Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
| | - Dipika Bansal
- Clinical Research Unit, Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
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Setchell J, Turpin M, Costa N, Hodges P. Web-Based Consumer Health Education About Back Pain: Findings of Potential Tensions From a Photo-Elicitation and Observational Study. JMIR Rehabil Assist Technol 2020; 7:e17130. [PMID: 32478663 PMCID: PMC7296418 DOI: 10.2196/17130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/24/2020] [Accepted: 03/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a leading cause of disability worldwide, with huge social and economic impact. There is extensive extant literature investigating the efficacy of various management approaches ranging from surgery to psychological interventions to exercise. However, this work has focused almost entirely on efficacy in terms of pain reduction, functional improvement, and psychological changes. This focus has meant that unanticipated social or socio-cultural effects of back pain health care have received little attention. OBJECTIVE This study aimed to scrutinize some of the conceptual tensions inherent in contemporary LBP health care approaches and to highlight their material effects. METHODS We used a qualitative research design adapted from discourse analysis, which was able to consider key discursive tensions underpinning a LBP website. Data collection involved observing the interaction between adult participants with LBP and the website in the following two ways: (1) observational interview, where participants were observed interacting with the website for the first time and asked to discuss their responses to it as they moved through the website and (2) photo-elicitation, where for a month after their first use of the website, people took photographs of what was happening in their lives when they thought of the website and discussed them in a follow-up interview. We used a postcritical discourse analysis approach to examine data produced from these methods. RESULTS Our postcritical discourse analysis identified key discursive tensions, including between living with and reducing LBP, keeping active and resting, and patient choice and giving guidance. CONCLUSIONS Our analysis suggests ways for considering less dominant perspectives without having to discard the benefits of dominant ones. Although the focus of LBP discourses has changed (less biomedical and less about cure), they still hold on to some of the problematic dominant paradigmatic concepts such as biomedicine and individualism. The tensions we highlight are likely to be highly useful for teaching and implementing LBP care across multiple health care settings.
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Affiliation(s)
- Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Merrill Turpin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nathalia Costa
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Paul Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Wippert PM, Puschmann AK, Drießlein D, Banzer W, Beck H, Schiltenwolf M, Schneider C, Mayer F. Personalized Treatment Suggestions: The Validity and Applicability of the Risk-Prevention-Index Social in Low Back Pain Exercise Treatments. J Clin Med 2020; 9:jcm9041197. [PMID: 32331301 PMCID: PMC7230931 DOI: 10.3390/jcm9041197] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 12/22/2022] Open
Abstract
Background: The back pain screening tool Risk-Prevention-Index Social (RPI-S) identifies the individual psychosocial risk for low back pain chronification and supports the allocation of patients at risk in additional multidisciplinary treatments. The study objectives were to evaluate (1) the prognostic validity of the RPI-S for a 6-month time frame and (2) the clinical benefit of the RPI-S. Methods: In a multicenter single-blind 3-armed randomized controlled trial, n = 660 persons (age 18–65 years) were randomly assigned to a twelve-week uni- or multidisciplinary exercise intervention or control group. Psychosocial risk was assessed by the RPI-S domain social environment (RPI-SSE) and the outcome pain by the Chronic Pain Grade Questionnaire (baseline M1, 12-weeks M4, 24-weeks M5). Prognostic validity was quantified by the root mean squared error (RMSE) within the control group. The clinical benefit of RPI-SSE was calculated by repeated measures ANOVA in intervention groups. Results: A subsample of n = 274 participants (mean = 38.0 years, SD 13.1) was analyzed, of which 30% were classified at risk in their psychosocial profile. The half-year prognostic validity was good (RMSE for disability of 9.04 at M4 and of 9.73 at M5; RMSE for pain intensity of 12.45 at M4 and of 14.49 at M5). People at risk showed significantly stronger reduction in pain disability and intensity at M4/M5, if participating in a multidisciplinary exercise treatment. Subjects at no risk showed a smaller reduction in pain disability in both interventions and no group differences for pain intensity. Regarding disability due to pain, around 41% of the sample would gain an unfitted treatment without the back pain screening. Conclusion: The RPI-SSE prognostic validity demonstrated good applicability and a clinical benefit confirmed by a clear advantage of an individualized treatment possibility.
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Affiliation(s)
- Pia-Maria Wippert
- Sociology of Health and Physical Activity, University of Potsdam, 14469 Potsdam, Germany;
- Laboratory of Movement Biomechanics, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
- Correspondence: ; Tel.: +0049-331-9771051
| | - Anne-Katrin Puschmann
- Sociology of Health and Physical Activity, University of Potsdam, 14469 Potsdam, Germany;
| | - David Drießlein
- Statistical Consulting Unit StaBLab, Ludwig-Maximilians-Universität München, 80539 Munich, Germany;
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University Frankfurt, 60323 Frankfurt am Main, Germany;
| | - Heidrun Beck
- University Hospital Carl Gustav Carus at Technical University Dresden, 01307 Dresden, Germany;
| | - Marcus Schiltenwolf
- Pain Management, Centre of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany;
| | | | - Frank Mayer
- University Outpatient Clinic, Centre of Sports Medicine, University of Potsdam, 14469 Potsdam, Germany;
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Efficacy of Tuina in patients with chronic low back pain: study protocol for a randomized controlled trial. Trials 2020; 21:271. [PMID: 32178704 PMCID: PMC7077020 DOI: 10.1186/s13063-020-4198-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Low back pain is a common reason for medical care and carries a heavy social burden. The efficacy of Tuina or health care education for low back pain has been evaluated in previous systematic reviews. However, there is no evidence to support the superiority of one form of treatment over another. The aim of this study is to compare the efficacy of Tuina with health care education in the management of low back pain. METHODS/DESIGN This study is a randomized controlled trial with parallel-group design including two groups: a Tuina group and a health care education group. A total of 160 eligible participants will be randomly assigned to the groups in a 1:1 ratio. The interventions of both groups will last for 20 min and be carried out twice each week for a period of 12 weeks. The primary outcome is the Oswestry Disability Index. The secondary outcomes include a visual analogue scale and the 36-item Short Form Health Survey. They will be assessed at baseline, at the end of the intervention every month, and during 6 months and 9 months of follow-up by repeated measures analysis of variance. The significance level is 5%. The safety of Tuina and health care education will be evaluated after each treatment session. This study will focus on the value of Tuina and health care education for low back pain and will highlight any differences in the efficacy of the treatments. DISCUSSION This study will evaluate the efficacy and safety of Tuina intervention for low back pain, which could provide reliable evidence for clinical decision making for patients with low back pain. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1900022656. Registered on 23 April 2019.
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Park SY, Hwang EH, Cho JH, Kim KW, Ha IH, Kim MR, Nam K, Lee MH, Lee JH, Kim N, Shin BC. Comparative Effectiveness of Chuna Manipulative Therapy for Non-Acute Lower Back Pain: A Multi-Center, Pragmatic, Randomized Controlled Trial. J Clin Med 2020; 9:E144. [PMID: 31948083 PMCID: PMC7019562 DOI: 10.3390/jcm9010144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/17/2019] [Accepted: 01/02/2020] [Indexed: 12/19/2022] Open
Abstract
Current evidence on the effectiveness and safety of Chuna manipulative therapy (CMT) for managing non-acute lower back pain (LBP) is insufficient. We investigated the comparative effectiveness and safety of CMT, a Korean style of manipulation, plus usual care (UC) compared to UC alone for non-acute LBP. We conducted a parallel, two-armed, multi-centered, assessor blinded, pragmatic, randomized controlled trial at four major Korean medical hospitals. Overall, 194 patients were randomly allocated to either CMT plus UC (n = 97) or UC alone (n = 97), for six weeks of treatment and six months follow-up. The primary outcome was measured using the numerical rating scale (NRS) of LBP intensity at 7 weeks. Secondary outcomes included NRS of leg pain, Oswestry Disability Index (ODI) for functional disability, patient global impression of change (PGIC) scale, and safety. A total of 194 patients were included in the intention-to-treat analysis, and 174 patients provided complete data for the primary outcome. At 7 weeks, clinically significant differences between groups were observed in the NRS of LBP (CMT + UC: -3.02 ± 1.72, UC: -1.36 ± 1.75, p < 0.001), ODI scores (CMT + UC: -5.65 ± 4.29, UC: -3.72 ± 4.63, p = 0.003), NRS of leg pain (CMT + UC: -2.00 ± 2.33, UC: -0.44 ± 1.86, p < 0.0001), and PGIC (CMT + UC: -0.28 ± 0.85, UC: 0.01 ± 0.66, p = 0.0119). Mild to moderate safety concerns were reported in 21 subjects. CMT plus UC showed higher effectiveness compared to UC alone in patients with non-acute LBP in reducing LBP and leg pain and in improving function with good safety results using a powered sample size and including mid-term follow-up.
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Affiliation(s)
- Sun-Young Park
- Department of Korean Rehabilitation Medicine, Pusan National University Korean Medicine Hospital, Yangsan 50612, Korea; (S.-Y.P.); (E.-H.H.)
- Department of Korean Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
| | - Eui-Hyoung Hwang
- Department of Korean Rehabilitation Medicine, Pusan National University Korean Medicine Hospital, Yangsan 50612, Korea; (S.-Y.P.); (E.-H.H.)
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
| | - Jae-Heung Cho
- Department of Korean Rehabilitation Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul 05278, Korea; (J.-H.C.); (K.-W.K.)
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul 05278, Korea; (J.-H.C.); (K.-W.K.)
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Korea;
| | - Me-riong Kim
- Jaseng Hospital of Korean Medicine, Seoul 06110, Korea;
| | - Kibong Nam
- Mokhuri Neck & Back Hospital, Seoul 06272, Korea; (K.N.); (M.h.L.)
| | - Min ho Lee
- Mokhuri Neck & Back Hospital, Seoul 06272, Korea; (K.N.); (M.h.L.)
| | - Jun-Hwan Lee
- Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon 34054, Korea;
| | - Namkwen Kim
- Center for Comparative Effectiveness Research & Economic Evaluation in Korean Medicine, Pusan National University, Yangsan 50612, Korea;
| | - Byung-Cheul Shin
- Department of Korean Rehabilitation Medicine, Pusan National University Korean Medicine Hospital, Yangsan 50612, Korea; (S.-Y.P.); (E.-H.H.)
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Korea
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Zhang C, Li Q, Li F, Zhang Y, Tang Y, Hou J, Yang R. Post-Arthroscopic Rotator Cuff Repair Rehabilitation Booklet: A Patient-Based Evaluation. Patient Prefer Adherence 2020; 14:1493-1500. [PMID: 32943847 PMCID: PMC7478374 DOI: 10.2147/ppa.s263645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lack of physical therapists has led to increment of self-managed rehabilitations in post-arthroscopic rotator cuff repair (ARCR) in the forms of booklets or leaflets. PURPOSE The aim of study is to investigate 1) the acceptance of post-ARCR patients towards an education booklet, and 2) whether it could be a timesaving and laborsaving tool to physical therapists. METHODS An education booklet was established through a systematic review. Patients who underwent ARCR in our hospital were included and randomly assigned to the intervention or control group (27 women, 21 men, mean age=57.06 years old). Patients in the intervention group received educational booklets, and an evaluation was also obtained after they finished reading. Patients' understanding of the booklet was determined by asking patients to re-enact training presented in the booklet. Then, a therapist blinded to allocations would personally demonstrate training to patients until patients fully understood the protocol. For the control group, the same therapist coached patients until the whole protocol was clearly understood. The coaching time for patients in both groups was recorded. RESULTS Out of 48 patients, 24 (50%) were randomly assigned to the intervention group, and 21 (87.50%) completed their questionnaire. Out of these 21 patients, 20 (95.24%) rated the booklet as "excellent and easy to read", and 17 (80.95%) felt that the booklet was helpful. The re-enaction accuracy was for strengthening training and specific training (71.43% and 61.90%, respectively). As compared to the control group, the time of coaching for the patients to fully master the protocol in the intervention group was significantly less (P<0.01). CONCLUSION Patients highly applauded this booklet, and they cherished the information and support it contained. Nevertheless, the re-enaction accuracy was not high, suggesting that the high level of acceptance does not guarantee full understanding of information sent to patients.
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Affiliation(s)
- Congda Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Qingyue Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Fangqi Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yuanhao Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yiyong Tang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Jingyi Hou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Rui Yang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Correspondence: Rui Yang; Jingyi Hou Tel +86 13694200667; +86 18102769380Fax +86 81332199 Email ;
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Wippert PM, Drießlein D, Beck H, Schneider C, Puschmann AK, Banzer W, Schiltenwolf M. The Feasibility and Effectiveness of a New Practical Multidisciplinary Treatment for Low-Back Pain: A Randomized Controlled Trial. J Clin Med 2019; 9:E115. [PMID: 31906224 PMCID: PMC7019545 DOI: 10.3390/jcm9010115] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022] Open
Abstract
Low-back pain is a major health problem exacerbated by the fact that most treatments are not suitable for self-management in everyday life. Particularly, interdisciplinary programs consist of intensive therapy lasting several weeks. Additionally, therapy components are rarely coordinated regarding reinforcing effects, which would improve complaints in persons with higher pain. This study assesses the effectiveness of a self-management program, firstly for persons suffering from higher pain and secondly compared to regular routines. Study objectives were treated in a single-blind multicenter controlled trial. A total of n = 439 volunteers (age 18-65 years) were randomly assigned to a twelve-week multidisciplinary sensorimotor training (3-weeks-center- and 9-weeks-homebased) or control group. The primary outcome pain (Chronic-Pain-Grade) as well as mental health were assessed by questionnaires at baseline and follow-up (3/6/12/24 weeks, M2-M5). For statistical analysis, multiple linear regression models were used. N = 291 (age 39.7 ± 12.7 years, female = 61.1%, 77% CPG = 1) completed training (M1/M4/M5), showing a significantly stronger reduction of mental health complaints (anxiety, vital exhaustion) in people with higher than those with lower pain in multidisciplinary treatment. Compared to regular routines, the self-management-multidisciplinary treatment led to a clinically relevant reduction of pain-disability and significant mental health improvements. Low-cost exercise programs may provide enormous relief for therapeutic processes, rehabilitation aftercare, and thus, cost savings for the health system.
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Affiliation(s)
- Pia-Maria Wippert
- Sociology of Health and Physical Activity, University of Potsdam, 14469 Potsdam, Germany;
- Department of Health Sciences and Technology, Laboratory of Movement Biomechanics, ETH Zürich, CH-8092 Zurich, Switzerland
| | - David Drießlein
- Statistical Consulting Unit StaBLab, Ludwig-Maximilians-Universität München, 80539 Munich, Germany;
| | - Heidrun Beck
- University Hospital Carl Gustav Carus at Technical University Dresden, 01307 Dresden, Germany;
| | | | - Anne-Katrin Puschmann
- Sociology of Health and Physical Activity, University of Potsdam, 14469 Potsdam, Germany;
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University Frankfurt, 60323 Frankfurt am Main, Germany;
| | - Marcus Schiltenwolf
- Pain Management, Centre of Orthopaedics and Trauma Surgery, Conservative Orthopaedics and Pain Management, Heidelberg University Hospital, 69120 Heidelberg, Germany;
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Traeger AC, Lee H, Hübscher M, Skinner IW, Moseley GL, Nicholas MK, Henschke N, Refshauge KM, Blyth FM, Main CJ, Hush JM, Lo S, McAuley JH. Effect of Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low Back Pain: A Randomized Clinical Trial. JAMA Neurol 2019; 76:161-169. [PMID: 30398542 DOI: 10.1001/jamaneurol.2018.3376] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Many patients with acute low back pain do not recover with basic first-line care (advice, reassurance, and simple analgesia, if necessary). It is unclear whether intensive patient education improves clinical outcomes for those patients already receiving first-line care. Objective To determine the effectiveness of intensive patient education for patients with acute low back pain. Design, Setting, and Participants This randomized, placebo-controlled clinical trial recruited patients from general practices, physiotherapy clinics, and a research center in Sydney, Australia, between September 10, 2013, and December 2, 2015. Trial follow-up was completed in December 17, 2016. Primary care practitioners invited 618 patients presenting with acute low back pain to participate. Researchers excluded 416 potential participants. All of the 202 eligible participants had low back pain of fewer than 6 weeks' duration and a high risk of developing chronic low back pain according to Predicting the Inception of Chronic Pain (PICKUP) Tool, a validated prognostic model. Participants were randomized in a 1:1 ratio to either patient education or placebo patient education. Interventions All participants received recommended first-line care for acute low back pain from their usual practitioner. Participants received additional 2 × 1-hour sessions of patient education (information on pain and biopsychosocial contributors plus self-management techniques, such as remaining active and pacing) or placebo patient education (active listening, without information or advice). Main Outcomes and Measures The primary outcome was pain intensity (11-point numeric rating scale) at 3 months. Secondary outcomes included disability (24-point Roland Morris Disability Questionnaire) at 1 week, and at 3, 6, and 12 months. Results Of 202 participants randomized for the trial, the mean (SD) age of participants was 45 (14.5) years and 103 (51.0%) were female. Retention rates were greater than 90% at all time points. Intensive patient education was not more effective than placebo patient education at reducing pain intensity (3-month mean [SD] pain intensity: 2.1 [2.4] vs 2.4 [2.2]; mean difference at 3 months, -0.3 [95% CI, -1.0 to 0.3]). There was a small effect of intensive patient education on the secondary outcome of disability at 1 week (mean difference, -1.6 points on a 24-point scale [95% CI, -3.1 to -0.1]) and 3 months (mean difference, -1.7 points, [95% CI, -3.2 to -0.2]) but not at 6 or 12 months. Conclusions and Relevance Adding 2 hours of patient education to recommended first-line care for patients with acute low back pain did not improve pain outcomes. Clinical guideline recommendations to provide complex and intensive support to high-risk patients with acute low back pain may have been premature. Trial Registration Australian Clinical Trial Registration Number: 12612001180808.
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Affiliation(s)
- Adrian C Traeger
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hopin Lee
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Markus Hübscher
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Ian W Skinner
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - G Lorimer Moseley
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Michael K Nicholas
- University of Sydney at Royal North Shore Hospital, Pain Management Research Institute, Sydney, New South Wales, Australia
| | - Nicholas Henschke
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kathryn M Refshauge
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Centre for Education and Research on Ageing, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris J Main
- Arthritis Care UK National Primary Care Centre, Keele University, North Staffordshire, United Kingdom
| | - Julia M Hush
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Institute for Research and Medical Consultations, University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - James H McAuley
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Joypaul S, Kelly F, McMillan SS, King MA. Multi-disciplinary interventions for chronic pain involving education: A systematic review. PLoS One 2019; 14:e0223306. [PMID: 31577827 PMCID: PMC6774525 DOI: 10.1371/journal.pone.0223306] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There have been growing recommendations to include education in multi-disciplinary interventions targeting chronic pain management. However, effects of this strategy on short- and long-term self-management of chronic pain, remain largely unexplored. OBJECTIVES 1. To provide an updated overview of studies that report on the impact of patient education in multi-disciplinary interventions, on self-management of chronic pain; 2. To explore associations between education and chronic pain self-management techniques; and 3. To identify the format and duration of suitable chronic pain interventions targeted at patient self-management. METHODS Design: Narrative systematic literature review of randomised or controlled study designs. Data Sources: PubMed, CINAHL, EMBASE, PsycINFO. Participants: Adult patients with chronic pain of any aetiology participating in multi-disciplinary programs that included education. Main outcome measures: Assessments of level of pain, function, quality of life, self-efficacy, self-management, and any other relevant assessments. Study Appraisal and Synthesis Methods: PRISMA guidelines, Cochrane Risk of Bias tool, and TIDieR model. RESULTS Database searching identified 485 potential papers. After removal of duplicates, and irrelevant articles by title and abstract, 120 full-text articles were reviewed and 27 studies were included in this systematic review. Studies were predominantly from the United States (n = 8; 29.6%). Over one hundred outcome measures were identified across all studies, with significant variation also observed in terms of how chronic pain duration was defined, and how education was delivered to participants. Overall, positive benefits of education were reported. CONCLUSIONS Education, as part of multi-disciplinary programs, is likely to improve self-management and self-efficacy in people with chronic pain of any aetiology. Heterogeneity in terms of: chronic pain duration; educational resources; healthcare professionals; and outcome measures, were identified as limitations. Further research, in the form of Randomised Controlled Trials addressing these limitations, is recommended.
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Affiliation(s)
- Shirdhya Joypaul
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Fiona Kelly
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Sara S. McMillan
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Michelle A. King
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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Gianola S, Castellini G, Andreano A, Corbetta D, Frigerio P, Pecoraro V, Redaelli V, Tettamanti A, Turolla A, Moja L, Valsecchi MG. Effectiveness of treatments for acute and sub-acute mechanical non-specific low back pain: protocol for a systematic review and network meta-analysis. Syst Rev 2019; 8:196. [PMID: 31395091 PMCID: PMC6688358 DOI: 10.1186/s13643-019-1116-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 07/24/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Non-specific low back pain (LBP) is the leading cause of disability worldwide. Acute LBP usually has a good prognosis, with rapid improvement within the first 6 weeks. However, the majority of patients develop chronic LBP and suffer from recurrences. For clinical management, a plethora of treatments is currently available but evidence of the most effective options is lacking. The objective of this study will be to identify the most effective interventions to relieve pain and reduce disability in acute and sub-acute non-specific LBP. METHODS/DESIGN We will search electronic databases (MEDLINE, Embase, CENTRAL) from inception onwards. The eligible population will be individuals with non-specific LBP older than 18 years, both males and females, who experience pain less than 6 weeks (acute) or between 6 and 12 weeks (subacute). Eligible interventions and comparators will include all conservative rehabilitation or pharmacological treatments provided by any health professional; the only eligible study design will be a randomized controlled trial. The primary outcomes will be pain intensity and back-specific functional status. Secondary outcomes will be any adverse events. Studies published in languages other than English will also potentially be included. Two reviewers will independently screen the titles and abstracts retrieved from a literature search, as well as potentially relevant full-text articles. General characteristics, potential effect modifiers, and outcome data will be extracted from the included studies, and the risk of bias will be appraised. Conflicts at all levels of screening and abstraction will be resolved through team discussions. After describing the results of the review, if appropriate, a random effects meta-analysis and network meta-analysis will be conducted in a frequentist setting, assuming equal heterogeneity across all treatment comparisons and accounting for correlations induced by multi-arm studies using a multivariate normal model. DISCUSSION Our systematic review will address the uncertainties in the use of pharmacological or non-pharmacological treatments, and their relative efficacy, for acute and subacute LBP. These findings will be useful for patients, healthcare providers, and policymakers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018102527.
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Affiliation(s)
- Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Anita Andreano
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
| | - Davide Corbetta
- Rehabilitation and Functional Recovery Department, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Pamela Frigerio
- Child and Adolescent Neuropsychiatric Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valentina Pecoraro
- Department of Laboratory Medicine, OCSAE, Azienda USL of Modena, Modena, Italy
| | | | - Andrea Tettamanti
- Rehabilitation and Functional Recovery Department, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Turolla
- Laboratory for Neurorehabilitation Technologies, Fondazione Ospedale San Camillo IRCCS, Venice, Italy
| | - Lorenzo Moja
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Podlog L, Burns R, Dimmock JA, Jackson B, Hall MS, Fritz JM. Does motivation mediate the relationship between competence perceptions and patient outcomes among individuals with chronic low back pain? A multiple mediation analysis. Disabil Rehabil 2019; 43:953-959. [PMID: 31345072 DOI: 10.1080/09638288.2019.1643421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to examine: (1) motivations of patients with chronic low back pain to attend physical therapy; (2) relationships between competence perceptions, motivational regulations, and pain/disability; and (3) whether patient motivations to attend physical therapy mediate the relationship between competence perceptions and pain/disability. METHODS A sample of 64 participants completed baseline assessment (1-week prior to initiation of physical therapy) and 6-week follow-up assessment. Differences between motivation variables at baseline were examined using one-way within-person ANOVA. Relationships between competence perceptions, motivation subscales, and pain/disability were calculated using bivariate correlations and multiple mediation analyses. RESULTS Participants reported significantly higher levels of autonomous versus controlled motivation (mean difference = 3.5, p < 0.001, d = 2.3) and amotivation (mean difference = 3.6, p < 0.001, d = 2.4). Competence was positively associated with autonomous motivation (r = 0.45, p ≤ 0.05) and negatively associated with controlled motivation (r = -0.26, p ≤ 0.05), amotivation (r = -0.57, p ≤ 0.05), pain (r = -0.35, p ≤ 0.05), and disability (r = -0.34, p ≤ 0.05). Amotivation significantly mediated the competence-pain relationship (Amotivation IE = -0.19, 95% CI (-0.44, -0.06), p < 0.05) and the competence-disability relationship (Amotivation IE = -0.07, 95% CI (-0.17, -0.01), p < 0.05). CONCLUSION Findings highlight the role of competence perceptions in mitigating amotivation for physical therapy and the deleterious implications of amotivation for patient-centered outcomes.Implications for rehabilitationWhile it is normal for patients to experience periods where they lack motivation for rehabilitation exercises, practitioners can encourage patients to assume responsibility for their recovery by informing them that amotivated states may increase the likelihood of increased pain perceptions and disability.Health-care practitioners should seek to foster competence perceptions in patients about to undergo physical therapy.Competence building strategies such as patient education, goal setting, and role modeling may be valuable in facilitating autonomous motivation and reducing amotivation for physical therapy.
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Affiliation(s)
- Leslie Podlog
- Department of Health, Kinesiology and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Ryan Burns
- Department of Health, Kinesiology and Recreation, University of Utah, Salt Lake City, UT, USA
| | - James A Dimmock
- School of Human Sciences, The University of Western Australia, Crawley, Australia
| | - Ben Jackson
- School of Human Sciences, The University of Western Australia, Crawley, Australia
| | - Morgan S Hall
- Department of Health, Kinesiology and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Julie M Fritz
- Department of Health, Kinesiology and Recreation, University of Utah, Salt Lake City, UT, USA
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Meyer T, Wulff K. Issues of comorbidity in clinical guidelines and systematic reviews from a rehabilitation perspective. Eur J Phys Rehabil Med 2019; 55:364-371. [DOI: 10.23736/s1973-9087.19.05786-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gardner T, Refshauge K, McAuley J, Hübscher M, Goodall S, Smith L. Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: a randomised controlled trial. Br J Sports Med 2019; 53:1424-1431. [PMID: 30808666 DOI: 10.1136/bjsports-2018-100080] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND One model of care that has not been tested for chronic low back pain (LBP) is patient-led goal setting. We aimed to compare the clinical effectiveness and healthcare use of a patient-led goal setting approach (intervention) with simple advice to exercise (control) over 12 months. METHODS An assessor-blinded randomised controlled trial. Intervention was education combined with patient-led goal setting compared with a control group receiving a standardised exercise programme. The primary outcomes were back pain disability and pain intensity. Secondary outcomes were quality of life, kinesiophobia, self-efficacy, depression, anxiety and stress. Outcomes and healthcare use were assessed immediately post-treatment (2 months) and after 4 and 12 months. Analysis was by intention to treat. RESULTS Seventy-five patients were randomly assigned to either the intervention (n=37) or the control (n=38) group. Using linear mixed model analyses, adjusted mean changes in primary outcomes of disability and pain intensity were greater in the intervention group than in the control group (disability post-treatment: p<0.05). These differences were clinically meaningful. Mean differences in all secondary measures were greater in the intervention group than in the control group (p<0.05). There was no difference in healthcare use between groups over 12 months. CONCLUSION A patient-led goal setting intervention was significantly more effective than advice to exercise for improving outcomes in disability, pain intensity, quality of life, self-efficacy and kinesiophobia in chronic LBP. These improvements were maintained at 12 months. Smaller effects were seen in measures of depression, anxiety and stress. TRIAL REGISTRATION NUMBER ACTRN12614000830695.
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Affiliation(s)
- Tania Gardner
- Department of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia
| | - Kathryn Refshauge
- Department of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - James McAuley
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, Australia
| | - Markus Hübscher
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Stephen Goodall
- Centre for Health Economics Research & Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Lorraine Smith
- Department of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia
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Voigt-Radloff S, Schöpf AC, Boeker M, Frank L, Farin E, Kaier K, Körner M, Wollmann K, Lang B, Meerpohl JJ, Möhler R, Niebling W, Serong J, Lange R, van der Keylen P, Maun A. Well informed physician-patient communication in consultations on back pain - study protocol of the cluster randomized GAP trial. BMC FAMILY PRACTICE 2019; 20:33. [PMID: 30803433 PMCID: PMC6388488 DOI: 10.1186/s12875-019-0925-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Back pain is one of the most frequent causes of health-related work absence. In Germany, more than 70% of adults suffer from at least one back pain episode per annum. It has strong impact on health care costs and patients' quality of life. Patients increasingly seek health information on the internet. However, judging its trustworthiness is difficult. In addition, physicians who are being confronted with this type of information often experience it to complicate the physician-patient interaction. The GAP trial aims to develop, implement and evaluate an evidence-based, easy-to-understand and trustworthy internet information portal on lower back pain to be used by general practitioners and patients during and after the consultation. Effectiveness of GAP portal use compared to routine consultation on improving communication and informedness of both physicians and patients will be assessed. In addition, effects on health care costs and patients' days of sick leave will be evaluated. METHODS We will conduct a prospective multi-centre, cluster-randomized parallel group trial including 1500 patients and 150 recruiting general practitioners. The intervention group will have access to the GAP portal. The portal will contain brief guides for patients and physicians on how to improve the consultation as well as information on epidemiology, aetiology, symptoms, benefits and harms of treatment options for acute, sub-acute and chronic lower back pain. The GAP portal will be designed to be user-friendly and present information on back pain tailored for either patients or physicians in form of brief fact sheets, educative videos, info-graphics, animations and glossaries. Physicians and patients will assess their informedness and the physician-patient communication in consultations at baseline and at two time points after the consultations under investigation. Days of sick leave and health care costs related to back pain will be compared between control and intervention group using routine data of company health insurance funds. DISCUSSION The GAP-trial intends to improve the communication between physicians and their patients and the informedness of both groups. If proven beneficial, the evidence-based and user-friendly portal will be made accessible for all patients and health professionals in back pain care. Inclusion of further indications might be implemented and evaluated in the long term. TRIAL REGISTRATION German Clinical Trials Register DRKS00014279 (registered 27th of April 2018).
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Affiliation(s)
- Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
| | - Andrea C. Schöpf
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Martin Boeker
- Medical Data Science, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Luca Frank
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Division Methods in Clinical Epidemiology, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs-University, Freiburg, Germany
| | - Katharina Wollmann
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
- Cochrane Germany Foundation, Freiburg, Germany
| | - Britta Lang
- Clinical Trials Unit of the Medical Center, University of Freiburg, Freiburg, Germany
| | - Joerg J. Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
| | - Ralph Möhler
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wilhelm Niebling
- Division of General Practice, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Serong
- Institute for Journalism, Technical University of Dortmund, Dortmund, Germany
| | - Renate Lange
- Bavarian State Association of Company Health Insurance Funds, Bavarian, Germany
| | - Piet van der Keylen
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany
| | - Andy Maun
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Division of General Practice, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Ibrahim AA, Akindele MO, Ganiyu SO, Bello B. Effects of motor control exercise and patient education program in the management of chronic low back pain among community-dwelling adults in rural Nigeria: a study protocol for a randomized clinical trial. Integr Med Res 2019; 8:71-81. [PMID: 31080731 PMCID: PMC6506610 DOI: 10.1016/j.imr.2019.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 01/10/2023] Open
Abstract
Background The impact of chronic low back pain (CLBP) is disproportionally higher in rural Nigeria than in urban areas but lack access to rehabilitation. While exercise and education are commonly advocated interventions for the rehabilitation of CLBP, there is a paucity of community-based randomized clinical trials assessing their benefits among adults with CLBP in rural Nigeria. The purpose of this study is to investigate the effects of motor control exercise (MCE) and patient education (PE) in the management of CLBP among community-dwelling adults in rural Nigeria. Methods This is an assessor-blind, three-arm parallel randomized clinical trial and will be conducted at Tsakuwa Primary Health Care Center in Kano, Northwestern Nigeria. One hundred and twenty adults with CLBP will be recruited and randomized to one of three intervention arms; MCE plus PE, MCE, or PE groups. The MCE will be administered twice a week for 8 weeks while the PE will be provided once a week for 8 weeks. Participants will be assessed pre-intervention, immediately post-intervention and at 3-month post-intervention. Primary outcomes will be pain intensity and functional disability. Secondary outcomes will be quality of life, fear-avoidance beliefs, pain catastrophizing, back beliefs, global perceived recovery, and physical performance. Discussion This will be the first community-based trial to assess the benefits of exercise and education in the management of CLBP among adults in rural Nigeria. The study may provide a relatively inexpensive, assessable, and effective alternative intervention for reducing CLBP disability in a low-resource rural Nigerian community. Trial registration:This study is registered at ClinicalTrial.gov and the trial registration number is NCT03393104.
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Affiliation(s)
- Aminu A. Ibrahim
- Corresponding author at: Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, Kano, Nigeria.
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van Lunteren M, Scharloo M, Ez‐Zaitouni Z, de Koning A, Landewé R, Fongen C, Ramonda R, Kaptein AA, van Gaalen FA, van der Heijde D. The Impact of Illness Perceptions and Coping on the Association Between Back Pain and Health Outcomes in Patients Suspected of Having Axial Spondyloarthritis: Data From the SPondyloArthritis Caught Early Cohort. Arthritis Care Res (Hoboken) 2018; 70:1829-1839. [PMID: 29609197 PMCID: PMC6587858 DOI: 10.1002/acr.23566] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/27/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To investigate whether illness perceptions and coping influence the relationship between back pain and health outcomes in patients suspected of having axial spondyloarthritis (SpA). METHODS In the SPondyloArthritis Caught Early cohort, regression models were computed at baseline, with back pain intensity (range 0-10) as the determinant and health-related quality of life, the physical component summary score (PCS) and mental component summary (MCS) of the Short Form 36 (SF-36) health survey, or work productivity loss as outcomes. Subsequently, using Leventhal's Common-Sense Model of Self-Regulation, illness perceptions and, thereafter, coping were added to the models. Analyses were repeated for patients diagnosed and classified as having axial SpA according to the Assessment of SpondyloArthritis international Society axial SpA criteria (ASAS axial SpA), patients only diagnosed with axial SpA (axial SpA-diagnosed only), and those with chronic back pain. RESULTS A total of 424 patients (145 with ASAS axial SpA, 81 with only a diagnosis of axial SpA, and 198 with chronic back pain); 64% of the total group were female, the mean ± SD age was 30.9 ± 8.1 years, and the mean ± SD symptom duration was 13.3 ± 7.1 months) were studied. In all patients, the strength of the associations between back pain and the PCS, back pain and the MCS score, and back pain and loss of work productivity were decreased by adding illness perceptions to the model, but explained variance improved. Adding coping to these models did not change the results. Comparable results were observed in all subgroups. CONCLUSION Illness perception, but not coping, is important in the relationship between back pain and HRQoL and work productivity loss in patients suspected of having axial SpA, irrespective of subgroup. This finding suggests that targeting illness perceptions could improve health outcomes in patients suspected of having axial SpA.
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Affiliation(s)
| | | | | | | | - Robert Landewé
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlandsand Zuyderland Medical CenterHeerlenThe Netherlands
| | | | - Roberta Ramonda
- University of Padova, Padova, Italyand Groene Hart ZiekenhuisGoudaThe Netherlands
| | - Ad A. Kaptein
- Leiden University Medical CenterLeidenThe Netherlands
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Chou L, Ranger TA, Peiris W, Cicuttini FM, Urquhart DM, Briggs AM, Wluka AE. Patients' perceived needs for allied health, and complementary and alternative medicines for low back pain: A systematic scoping review. Health Expect 2018; 21:824-847. [PMID: 29983004 PMCID: PMC6186543 DOI: 10.1111/hex.12676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Allied health and complementary and alternative medicines (CAM) are therapeutic therapies commonly accessed by consumers to manage low back pain (LBP). We aimed to identify the literature regarding patients' perceived needs for physiotherapy, chiropractic therapy and CAM for the management of LBP. METHODS A systematic scoping review of MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016) was conducted to identify studies examining patients' perceived needs for allied health and CAM for LBP. Data regarding study design and methodology were extracted. Areas of patients' perceived need for allied health and CAM were aggregated. RESULTS Forty-four studies from 2202 were included: 25 qualitative, 18 quantitative and 1 mixed-methods study. Three areas of need emerged: (i) physiotherapy was viewed as important, particularly when individually tailored. However, patients had concerns about adherence, adverse outcomes and correct exercise technique. (ii) Chiropractic therapy was perceived to be effective and needed by some patients, but others were concerned about adverse outcomes. (iii) An inconsistent need for CAM was identified with some patients perceiving a need, while others questioning the legitimacy and short-term duration of these therapies. CONCLUSIONS Our findings regarding patients' perceived needs for allied health and CAM for LBP may assist in informing development of more patient-centred guidelines and service models for LBP. Understanding patients' concerns regarding active-based physiotherapy, which is recommended in most guidelines, and issues surrounding chiropractic and CAM, which are generally not, may help inform management that better aligns patient's perceived needs with effective treatments, to improve outcomes for both patients and the health-care system.
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Affiliation(s)
- Louisa Chou
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Tom A. Ranger
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Waruna Peiris
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Flavia M. Cicuttini
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Donna M. Urquhart
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
| | - Andrew M. Briggs
- School of Physiotherapy and Exercise ScienceCurtin UniversityPerthWAAustralia
- Move: Muscle, Bone & Joint HealthMelbourneVicAustralia
| | - Anita E. Wluka
- Department of Epidemiology and Preventative MedicineSchool of Public Health and Preventative MedicineMonash UniversityMelbourneVicAustralia
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Henningsen P, Zipfel S, Sattel H, Creed F. Management of Functional Somatic Syndromes and Bodily Distress. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:12-31. [PMID: 29306954 DOI: 10.1159/000484413] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 12/18/2022]
Abstract
Functional somatic syndromes (FSS), like irritable bowel syndrome or fibromyalgia and other symptoms reflecting bodily distress, are common in practically all areas of medicine worldwide. Diagnostic and therapeutic approaches to these symptoms and syndromes vary substantially across and within medical specialties from biomedicine to psychiatry. Patients may become frustrated with the lack of effective treatment, doctors may experience these disorders as difficult to treat, and this type of health problem forms an important component of the global burden of disease. This review intends to develop a unifying perspective on the understanding and management of FSS and bodily distress. Firstly, we present the clinical problem and review current concepts for classification. Secondly, we propose an integrated etiological model which encompasses a wide range of biopsychosocial vulnerability and triggering factors and considers consecutive aggravating and maintaining factors. Thirdly, we systematically scrutinize the current evidence base in terms of an umbrella review of systematic reviews from 2007 to 2017 and give recommendations for treatment for all levels of care, concentrating on developments over the last 10 years. We conclude that activating, patient-involving, and centrally acting therapies appear to be more effective than passive ones that primarily act on peripheral physiology, and we recommend stepped care approaches that translate a truly biopsychosocial approach into actual management of the patient.
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Affiliation(s)
- Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Wippert PM, Wiebking C. Stress and Alterations in the Pain Matrix: A Biopsychosocial Perspective on Back Pain and Its Prevention and Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E785. [PMID: 29670003 PMCID: PMC5923827 DOI: 10.3390/ijerph15040785] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/02/2018] [Accepted: 04/09/2018] [Indexed: 12/18/2022]
Abstract
The genesis of chronic pain is explained by a biopsychosocial model. It hypothesizes an interdependency between environmental and genetic factors provoking aberrant long-term changes in biological and psychological regulatory systems. Physiological effects of psychological and physical stressors may play a crucial role in these maladaptive processes. Specifically, long-term demands on the stress response system may moderate central pain processing and influence descending serotonergic and noradrenergic signals from the brainstem, regulating nociceptive processing at the spinal level. However, the underlying mechanisms of this pathophysiological interplay still remain unclear. This paper aims to shed light on possible pathways between physical (exercise) and psychological stress and the potential neurobiological consequences in the genesis and treatment of chronic pain, highlighting evolving concepts and promising research directions in the treatment of chronic pain. Two treatment forms (exercise and mindfulness-based stress reduction as exemplary therapies), their interaction, and the dose-response will be discussed in more detail, which might pave the way to a better understanding of alterations in the pain matrix and help to develop future prevention and therapeutic concepts.
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Affiliation(s)
- Pia-Maria Wippert
- Sociology of Health and Physical Activity, Department of Health Science, University of Potsdam, Am Neuen Palais 10, House 12, 14469 Potsdam, Germany.
- Department of Health Sciences and Technology, ETH Zürich, HCP, Leopold-Ruzicka-Weg 4, CH-8093 Zürich, Switzerland.
| | - Christine Wiebking
- Sociology of Health and Physical Activity, Department of Health Science, University of Potsdam, Am Neuen Palais 10, House 12, 14469 Potsdam, Germany.
- Institute of Psychology and Education, Applied Emotion and Motivation Research, Ulm University, 89081 Ulm, Germany.
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Gellert P, Ernsting C, Salm F, Oedekoven M, Kanzler M, Kuhlmey A. Disease-specific knowledge in individuals with and without chronic conditions. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-017-0855-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Chenot JF, Greitemann B, Kladny B, Petzke F, Pfingsten M, Gabriele Schorr S. Non-Specific Low Back Pain. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:883-890. [PMID: 29321099 PMCID: PMC5769319 DOI: 10.3238/arztebl.2017.0883] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 07/28/2017] [Accepted: 10/26/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND For many years, low back pain has been both the leading cause of days lost from work and the leading indication for medical rehabilitation. The goal of the German Disease Management Guideline (NDMG) on nonspecific low back pain is to improve the treatment of patients with this condition. METHODS The current update of the NDMG on non-specific low back pain is based on articles retrieved by a systematic search of the literature for systematic reviews. Its recommendations for diagnosis and treatment were developed by a collaborative effort of 29 scientific medical societies and organizations and approved in a formal consensus process. RESULTS If the history and physical examination do not arouse any suspicion of a dangerous underlying cause, no further diagnostic evaluation is indicated for the time being. Passive, reactive measures should be taken only in combination with activating measures, or not at all. When drugs are used for symptomatic treatment, patients should be treated with the most suitable drug in the lowest possible dose and for as short a time as possible. CONCLUSION A physician should be in charge of the overall care process. The patient should be kept well informed over the entire course of his or her illness and should be encouraged to adopt a healthful lifestyle, including regular physical exercise.
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Affiliation(s)
- Jean-François Chenot
- Section Family Medicine, Institute for Community Medicine, University Hospital of Greifswald
| | | | - Bernd Kladny
- Department of Orthopedics, Fachklinik Herzogenaurach
| | - Frank Petzke
- ain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen
| | - Michael Pfingsten
- ain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen
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