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Mingels S, Granitzer M, Luedtke K, Dankaerts W. Therapeutic Patient Education as Part of the Physiotherapy Management of Adults with Headache: A Scoping Review. Curr Pain Headache Rep 2024; 28:547-564. [PMID: 38613735 DOI: 10.1007/s11916-024-01253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE OF REVIEW Physiotherapy interventions for headache mostly include exercise and manual therapy. Yet, the complex nature of headache, sometimes characterized by symptoms of facilitated central pain mechanisms, demands an individualized approach in which therapeutic patient education could be supportive. This scoping review aimed to summarize the position of therapeutic patient education within the physiotherapy management of adults with headache. PubMed, EMBASE, Web of Science, and Scopus were searched. The search-query comprised terminology relating to "headache", "education", and "physiotherapy". Eligibility criteria were: adults with headache, interventions including education within the domain of physiotherapy, reviews, clinical trials, cohort, case report, case-control studies. RECENT FINDINGS Eleven publications were included from the 281 retrieved publications. These publications were clinical trials (n = 4), reviews (n = 4), case-reports (n = 2), and a guideline (n = 1). Type of headaches studied were migraine (n = 3), post-traumatic headache (n = 2), tension-type headache (n = 2), cervicogenic headache (n = 1), primary headaches (n = 1), chronic daily headache (n = 1), and mixed migraine-cervicogenic headache (n = 1). Education seems an umbrella-term for postural education, lifestyle advice, and pain education. Three themes emerged across the publications: handling headache triggers (migraine, post-traumatic headache), promoting active lifestyle (post-traumatic headache, chronic daily headache, migraine), evaluating posture (post-traumatic headache, chronic daily headache, tension-type headache, cervicogenic headache). All publications recommended education in the management of headache. Only one (of the 11 included) publication described the educational program and determined its efficacy. Based on this scoping review, therapeutic patient education seems supported within physiotherapy management of headache. However, it is unclear how such education is tailored to the specific needs of the individual, the headache subtype, or when it should be added to physiotherapy management of headache.
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Affiliation(s)
- Sarah Mingels
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Tervuursevest, 101, 3001, Leuven, Belgium.
- Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium.
| | - Marita Granitzer
- Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
| | - Kerstin Luedtke
- Department of Physiotherapy, Pain and Exercise Research, Universität Zu Lübeck, Lübeck, Germany
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Tervuursevest, 101, 3001, Leuven, Belgium
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Ishaq I, Skinner IW, Mehta P, Walton DM, Bier J, Verhagen AP. Clinical validation of grouping conservative treatments in neck pain for use in a network meta-analysis: a Delphi consensus study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:166-175. [PMID: 37943373 DOI: 10.1007/s00586-023-08025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND A network meta-analysis aims to help clinicians make clinical decisions on the most effective treatment for a certain condition. Neck pain is multifactorial, with various classification systems and treatment options. Classifying patients and grouping interventions in clinically relevant treatment nodes for a NMA is essential, but this process is poorly defined. OBJECTIVE Our aim is to obtain consensus among experts on neck pain classifications and the grouping of interventions into nodes for a future network meta-analysis. DESIGN A Delphi consensus study involving neck pain experts worldwide. METHODS We invited authors of neck pain clinical practice guidelines published from 2014 onwards. The Delphi baseline questionnaire was developed based on the findings of a scoping review, including four items on classifications and 19 nodes. Participants were asked to record their level of agreement on a seven-point Likert scale or using Yes/No/Not sure answer options for the various statements. We used descriptive analysis to summarise the responses on each statement with content analysis of the free-text comments. RESULTS In total, 18/80 experts (22.5%) agreed to participate in one or more Delphi rounds. We needed three rounds to reach consensus for two classification of neck pain: one based on aetiology and one on duration. In addition, we also reached consensus on the grouping of interventions, including a definition of each node, with the number of nodes reduced to 17. CONCLUSION With this consensus we clinically validated two neck pain classifications and grouped conservative treatments into 17 well-defined and clinically relevant nodes.
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Affiliation(s)
- Iqra Ishaq
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, 100 Broadway, Ultimo, 2007, Australia
| | - Ian W Skinner
- School of Allied Health Exercise and Sports Sciences, Charles Sturt University, Port Macquarie, NSW, Australia
| | - Poonam Mehta
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, 100 Broadway, Ultimo, 2007, Australia
| | - David M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - Jasper Bier
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands
- FS Fysio, Capelle aan den IJssel, The Netherlands
| | - Arianne P Verhagen
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, 100 Broadway, Ultimo, 2007, Australia.
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Susana CT, Maria TML, Pilar DS, María MMT, Pilar MS, Valentín MG. Effectiveness of self-applied acupressure for cervical pain of benign origin (EDIDO-CUH): a randomized controlled clinical trial. Acupunct Med 2020; 39:441-451. [PMID: 33280397 PMCID: PMC8442130 DOI: 10.1177/0964528420961398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Cervical pain is a problem with a high prevalence of ~13% of the population,
and is more common in women (16.5%). The most affected age group is
65–74 years. Our aim was to assess the effectiveness of self-applied
acupressure for decreasing benign-origin cervical pain, under the
supervision of a health professional and in combination with usual
treatment, as well as to examine its impact on the patient’s self-perceived
health condition and their opinion of the technique. Methods: Pragmatic, multicenter, controlled clinical trial randomized by healthcare
center. A total of 160 patients with benign-origin cervical pain between 18
and 65 years of age who attended primary care were included from 12
healthcare centers in the autonomous community of Madrid by consecutive
sampling, and randomly assigned to a control or intervention group. The main
outcome variable was pain intensity measured on a visual analogue scale
(VAS) and secondary variables were self-perceived quality of life
(EuroQol-5D utility index) and functional ability (neck disability index).
An explanative model of generalized estimating equations was built taking
into account the lack of independence among observations. The analysis was
performed over 6 months. Results: In total, 150 patients completed the study. Mean age was 45 years (SD: 10.7),
86.7% were women, 86.2% were currently employed, and 57.9% did not perform
any physical exercise. Average days experiencing pain was 32.9 (SD: 2.8) and
80% were undergoing previous pharmacological treatment. The quality of life
utility index after 3 months was 1.6 points (95% CI: 0.54–2.71) higher in
the intervention group. The pain score on the VAS was 0.16 points (95% CI:
0.80–0.48) lower in the intervention group. The health professional
explained 10.4% of the reduction in pain observed on the VAS throughout the
medical visits. Conclusion: Acupressure applied in addition to usual practice appeared to improve
cervical pain in the long term. The effectiveness of this technique was
partially explained by the health professional that trained the participants
on technique application. Trial registration number:: NCT01855893
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Affiliation(s)
- Calvo Trujillo Susana
- Primary Care Carabanchel Alto, Gerencia Asistencial de Atención Primaria), SERMAS, Madrid, Spain
| | | | - Domenech Senra Pilar
- Primary Care Santa Mónica, Gerencia Asistencial de Atención Primaria, SERMAS, Madrid, Spain
| | | | - Marín Solano Pilar
- Primary Care Martinez de la Riva, Gerencia Asistencial de Atención Primaria, SERMAS, Madrid, Spain
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Louw A, Rico D, Langerwerf L, Maiers N, Diener I, Cox T. Preoperative pain neuroscience education for shoulder surgery: A case series. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1417. [PMID: 32935067 PMCID: PMC7479411 DOI: 10.4102/sajp.v76i1.1417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background Central sensitisation, in addition to high levels of fear-avoidance and pain catastrophisation may exist in a subgroup of patients with shoulder pain. Pain neuroscience education (PNE) has been shown to positively influence sensitivity of the nervous system, as well as reduce fear and catastrophisation prior to lumbar and total knee surgery. To date, no study has examined the application of PNE prior to shoulder surgery. Objectives This study examined the response to preoperative PNE in patients preparing for shoulder surgery. Method An exploratory pre–post case series was conducted. Twelve patients scheduled for surgery completed various pre-education measurements including shoulder pain, fear-avoidance, pain catastrophisation, beliefs and expectations regarding surgery, active shoulder flexion and pressure pain thresholds for the involved and uninvolved shoulder and the dominant-sided knee. Patients underwent a standard 30-min, one-on-one PNE session with a physiotherapist prior to surgery. Results Following education, all measures improved with some failing to reach significance: self-reported pain (p = 0.125), pain catastrophisation (p = 0.250) and pain pressure threshold of the uninvolved shoulder (p = 0.68) and knee (p = 0.097). Fear-avoidance (p = 0.013), active shoulder flexion (p = 0.013) and pain pressure threshold for the involved shoulder (p = 0.004) significantly improved. Conclusion A small patient group improved beyond minimal detectable change and/or minimal clinical important difference after education. No significant shifts of the preoperative beliefs occurred after education. Clinical implications Preoperative PNE may be beneficial to a subgroup of patients scheduled for shoulder surgery.
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Affiliation(s)
- Adriaan Louw
- Evidence in Motion, San Antonio, United States of America
| | - Debra Rico
- Department of Physical Therapy, Rockhurst University, Kansas City, United States of America
| | | | - Nicholas Maiers
- Department of Physical Therapy, Des Moines University, Des Moines, United States of America
| | - Ina Diener
- Department of Physiotherapy, Stellenbosch University, Cape Town, South Africa
| | - Terry Cox
- Department of Physical Therapy, Southwest Baptist University, Bolivar, United States of America
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Taylor SJC, Carnes D, Homer K, Pincus T, Kahan BC, Hounsome N, Eldridge S, Spencer A, Diaz-Ordaz K, Rahman A, Mars TS, Foell J, Griffiths CJ, Underwood MR. Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS). PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BackgroundChronic musculoskeletal pain is a common problem that is difficult to treat. Self-management support interventions may help people to manage this condition better; however, there is limited evidence showing that they improve clinical outcomes. Our overarching research question was ‘Does a self-management support programme improve outcomes for people living with chronic musculoskeletal pain?’.AimTo develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically grounded self-management support intervention for people living with chronic musculoskeletal pain.MethodsIn phase 1 we carried out two systematic reviews to synthesise the evidence base for self-management course content and delivery styles likely to help those with chronic pain. We also considered the psychological theories that might underpin behaviour change and pain management principles. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in Self-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session after 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with experience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the literature on potential outcome domains and measures and consulted widely with patients, tutors and experts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English and, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community. In phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of adding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain toolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and musculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire. We collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs, health utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression Scale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by participants were extracted from NHS electronic records.ResultsWe recruited 703 participants with a mean age of 60 years (range 19–94 years); 81% were white and 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and anxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants received 85% of the course content. At 12 months there was no difference between treatment groups in our primary outcome of pain-related disability [difference –1.0 intervention vs. control, 95% confidence interval (CI) –4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration all improved more in the intervention group at 6 months. At 1 year these differences remained for depression (–0.7, 95% CI –1.2 to –0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS intervention had a high probability (87%) of being cost-effective compared with usual care at a threshold of £30,000 per quality-adjusted life-year.ConclusionsAlthough the COPERS intervention did not affect our primary outcome of pain-related disability, it improved psychological well-being and is likely to be cost-effective according to current National Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a substitute for less well-evidenced (and more expensive) pain self-management programmes. Effective interventions to improve hard outcomes in chronic pain patients, such as disability, are still needed.Trial registrationCurrent Controlled Trials ISRCTN22714229.FundingThe project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stephanie JC Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Brennan C Kahan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natalia Hounsome
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anne Spencer
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Karla Diaz-Ordaz
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anisur Rahman
- Department of Rheumatology, University College Hospital, University College London, London, UK
| | - Tom S Mars
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jens Foell
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin R Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Bernhardsson S, Öberg B, Johansson K, Nilsen P, Larsson MEH. Clinical practice in line with evidence? A survey among primary care physiotherapists in western Sweden. J Eval Clin Pract 2015; 21:1169-77. [PMID: 25988993 DOI: 10.1111/jep.12380] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Evidence-based practice is becoming increasingly important in primary care physiotherapy. Clinical practice needs to reflect current best evidence and be concordant with evidence-based clinical guidelines. There is limited knowledge about therapeutic interventions used in primary care physiotherapy in Sweden. The objectives were to examine preferred treatment interventions reported by publicly employed physiotherapists in primary care for three common musculoskeletal disorders (low back pain, neck pain and subacromial pain), the extent to which these interventions were supported by evidence, and associations with demographic variables. METHODS 419 physiotherapists in primary care in western Sweden were surveyed using a validated web-based questionnaire. RESULTS The survey was completed by 271 respondents (65%). Median number of interventions reported was 7 (range 1-16). The most common treatment interventions across the three conditions were advice on posture (reported by 82-94%), advice to stay active (86-92%), and different types of exercise (65-92%). Most of these interventions were supported by evidence. However, interventions with insufficient evidence, such as advice on posture, TENS and aquatic exercise, were also used by 29-96%. Modalities such as laser therapy and ultrasound were sparingly used (<5%), which is in line with evidence. For neck pain, use of evidence-based interventions was associated with gender and for subacromial pain, with work experience. CONCLUSIONS Advice and exercise therapy were the interventions most frequently reported across the three diagnoses, illustrating an active treatment strategy. While most reported interventions are supported by evidence, interventions with unclear or no evidence of effect were also used to a high extent.
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Affiliation(s)
- Susanne Bernhardsson
- Närhälsan Rehabilitation, Region Västra Götaland, Hönö, Sweden.,Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Birgitta Öberg
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Kajsa Johansson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Per Nilsen
- Department of Medical and Health Sciences, Division of Social Medicine, Linköping University, Linköping, Sweden
| | - Maria E H Larsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Dorresteijn JAN, Kriegsman DMW, Assendelft WJJ, Valk GD. Patient education for preventing diabetic foot ulceration. Cochrane Database Syst Rev 2014; 2014:CD001488. [PMID: 25514250 PMCID: PMC7057029 DOI: 10.1002/14651858.cd001488.pub5] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ulceration of the feet, which can result in loss of limbs and even death, is one of the major health problems for people with diabetes mellitus. OBJECTIVES To assess the effects of patient education on the prevention of foot ulcers in patients with diabetes mellitus. SEARCH METHODS We searched The Cochrane Wounds Group Specialised Register (searched 03 September 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8). SELECTION CRITERIA Prospective randomised controlled trials (RCTs) that evaluated educational programmes for preventing foot ulcers in people with diabetes mellitus. DATA COLLECTION AND ANALYSIS Two review authors independently undertook data extraction and assessment of risk of bias. Primary end points were foot ulceration or ulcer recurrence and amputation. MAIN RESULTS Of the 12 RCTs included, the effect of patient education on primary end points was reported in only five. Pooling of outcome data was precluded by marked, mainly clinical, heterogeneity. One of the RCTs showed reduced incidence of foot ulceration (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.14 to 0.66) and amputation (RR 0.33, 95% CI 0.15 to 0.76) during one-year follow-up of diabetes patients at high risk of foot ulceration after a one-hour group education session. However, one similar study, with lower risk of bias, did not confirm this finding (RR amputation 0.98, 95% CI 0.41 to 2.34; RR ulceration 1.00, 95% CI 0.70 to 1.44). Three other studies, also did not demonstrate any effect of education on the primary end points, but were most likely underpowered. Patients' foot care knowledge was improved in the short term in five of eight RCTs in which this outcome was assessed, as was patients' self-reported self-care behaviour in the short term in seven of nine RCTs. Callus, nail problems and fungal infections improved in only one of five RCTs. Only one of the included RCTs was at low risk of bias. AUTHORS' CONCLUSIONS In some trials, foot care knowledge and self reported patient behaviour seem to be positively influenced by education in the short term. Yet, based on the only two sufficiently powered studies reporting the effect of patient education on primary end points, we conclude that there is insufficient robust evidence that limited patient education alone is effective in achieving clinically relevant reductions in ulcer and amputation incidence.
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Affiliation(s)
- Johannes AN Dorresteijn
- University Medical Center UtrechtDepartment of Internal MedicineHeidelberglaan 100UMCU postbox F02.1263508 GA UtrechtNetherlands
| | - Didi MW Kriegsman
- Zonnehuisgroep Amstelland (KBO)Laan van de Helende Meesters 12AmstelveenNetherlands1186 AM
| | - Willem JJ Assendelft
- Radboud University Nijmegen Medical CenterDepartment of Primary and Community Care, 117 ELGPO Box 9101route 117NijmegenNetherlands6500 HB
| | - Gerlof D Valk
- University Medical Center UtrechtDepartment of Internal MedicineHeidelberglaan 100UMCU postbox F02.1263508 GA UtrechtNetherlands
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Gross AR, Kaplan F, Huang S, Khan M, Santaguida PL, Carlesso LC, MacDermid JC, Walton DM, Kenardy J, Söderlund A, Verhagen A, Hartvigsen J. Psychological Care, Patient Education, Orthotics, Ergonomics and Prevention Strategies for Neck Pain: An Systematic Overview Update as Part of the ICON Project. Open Orthop J 2013; 7:530-61. [PMID: 24133554 PMCID: PMC3795400 DOI: 10.2174/1874325001307010530] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 03/28/2013] [Accepted: 03/28/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To conduct an overview on psychological interventions, orthoses, patient education, ergonomics, and 1⁰/2⁰ neck pain prevention for adults with acute-chronic neck pain. SEARCH STRATEGY Computerized databases and grey literature were searched (2006-2012). SELECTION CRITERIA Systematic reviews of randomized controlled trials (RCTs) on pain, function/disability, global perceived effect, quality-of-life and patient satisfaction were retrieved. DATA COLLECTION & ANALYSIS Two independent authors selected articles, assessed risk of bias using AMSTAR tool and extracted data. The GRADE tool was used to evaluate the body of evidence and an external panel to provide critical review. MAIN RESULTS We retrieved 30 reviews (5-9 AMSTAR score) reporting on 75 RCTs with the following moderate GRADE evidence. For acute whiplash associated disorder (WAD), an education video in emergency rooms (1RCT, 405participants] favoured pain reduction at long-term follow-up thus helping 1 in 23 people [Standard Mean Difference: -0.44(95%CI: -0.66 to -0.23)). Use of a soft collar (2RCTs, 1278participants) was not beneficial in the long-term. For chronic neck pain, a mind-body intervention (2RCTs, 1 meta-analysis, 191participants) improved short-term pain/function in 1 of 4 or 6 participants. In workers, 2-minutes of daily scapula-thoracic endurance training (1RCT, 127participants) over 10 weeks was beneficial in 1 of 4 participants. A number of psychosocial interventions, workplace interventions, collar use and self-management educational strategies were not beneficial. REVIEWERS' CONCLUSIONS Moderate evidence exists for quantifying beneficial and non-beneficial effects of a limited number of interventions for acute WAD and chronic neck pain. Larger trials with more rigorous controls need to target promising interventions.
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Affiliation(s)
| | | | | | | | - P. Lina Santaguida
- McMaster University Evidence-Based Practice Centre, Department of Clinical Epidemiology and Biostatistics, Hamilton, ON, Canada
| | - Lisa C. Carlesso
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Joy C. MacDermid
- School of Rehabilitation Sciences McMaster University, Hamilton, Ontario and Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph’s Health Centre, London, ON, Canada
| | - David M. Walton
- School of Physical Therapy, University of Western Ontario, London, ON, Canada
| | - Justin Kenardy
- Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Royal Brisbane and Women’s Hospital, QLD, Australia
| | - Anne Söderlund
- School of Health, Care and Social Welfare Malardalens University, Vasteras, Sweden
| | | | - Jan Hartvigsen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
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Affiliation(s)
- Edzard Ernst
- Peninsula Medical School; University of Exeter; Veysey Building, Salmon Pool Lane; Exeter; EX2 4SG; UK
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10
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What Does the Cochrane Collaboration Say about the Treatment of Pain? Physiother Can 2012; 63:383-4. [PMID: 22654244 DOI: 10.3138/physio.63.3.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mongini F, Evangelista A, Milani C, Ferrero L, Ciccone G, Ugolini A, Piedimonte A, Sigaudo M, Carlino E, Banzatti E, Galassi C. An educational and physical program to reduce headache, neck/shoulder pain in a working community: a cluster-randomized controlled trial. PLoS One 2012; 7:e29637. [PMID: 22253751 PMCID: PMC3253792 DOI: 10.1371/journal.pone.0029637] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 12/01/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Noninvasive physical management is often prescribed for headache and neck pain. Systematic reviews, however, indicate that the evidence of its efficacy is limited. Our aim was to evaluate the effectiveness of a workplace educational and physical program in reducing headache and neck/shoulder pain. METHODOLOGY/PRINCIPAL FINDINGS Cluster-randomized controlled trial. All municipal workers of the City of Turin, Italy, were invited to participate. Those who agreed were randomly assigned, according to their departments, to the intervention group (IG) or to the control group and were given diaries for the daily recording of pain episodes for 1 month (baseline). Subsequently, only the IG (119 departments, 923 workers) began the physical and educational program, whereas the control group (117 departments, 990 workers) did not receive any intervention. All participants were again given diaries for the daily recording of pain episodes after 6 months of intervention. The primary outcome was the change in the frequency of headache (expressed as the proportion of subjects with a ≥50% reduction of frequency; responder rate); among the secondary outcomes there were the absolute reduction of the number of days per month with headache and neck/shoulder pain. Differences between the two groups were evaluated using mixed-effect regression models. The IG showed a higher responder rate [risk ratio, 95% confidence interval (CI)] for headache (1.58; 1.28 to 1.92) and for neck/shoulder pain (1.53; 1.27 to 1.82), and a larger reduction of the days per month (95% CI) with headache (-1.72; -2.40 to -1.04) and with neck/shoulder pain (-2.51; -3.56 to -1.47). CONCLUSIONS The program effectively reduced headache and neck/shoulder pain in a large working community and appears to be easily transferable to primary-care settings. Further trials are needed to investigate the program effectiveness in a clinical setting, for highly selected patients suffering from specific headache types. TRIAL REGISTRATION ClinicalTrials.gov NCT00551980.
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Affiliation(s)
- Franco Mongini
- Section Headache-Facial Pain, Department of Clinical Pathophysiology, University of Turin, Turin, Italy.
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van Ittersum MW, van Wilgen CP, Groothoff JW, van der Schans CP. Is appreciation of written education about pain neurophysiology related to changes in illness perceptions and health status in patients with fibromyalgia? PATIENT EDUCATION AND COUNSELING 2011; 85:269-274. [PMID: 20880654 DOI: 10.1016/j.pec.2010.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 08/29/2010] [Accepted: 09/01/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To investigate the appreciation of written education about pain neurophysiology in patients with fibromyalgia (FM) and its effects on illness perceptions and perceived health status. METHODS A booklet explaining pain neurophysiology was sent to participants with FM. Appreciation was assessed with 10 questions addressing relevance (0-30) and reassurance (0-30). Illness perceptions, catastrophizing and health status were measured with the Revised Illness Perception Questionnaire (IPQ-R), the Pain Catastrophizing Scale (PCS) and the Fibromyalgia Impact Questionnaire (FIQ) at baseline (T0), after a 2-week control period (T1) and 6 weeks after the intervention (T2). RESULTS Forty-one patients participated. Mean (SD) scores for relevance and reassurance were 21.6 (5.6) and 18.7 (5.7), respectively. Only illness coherence, emotional representations, pain and fatigue changed significantly between T0 and T2. Correlations between appreciation and changes in outcomes ranged between r=0.00 and r=0.34. CONCLUSIONS Although a majority of subjects appreciated the written information, it did not have clinically relevant effects on illness perceptions, catastrophizing or impact of FM on daily life. PRACTICE IMPLICATIONS Written education about pain neurophysiology is inadequate toward changing illness perceptions, catastrophizing or perceived health status of participants with FM; education should be incorporated into a broader multidisciplinary self-management program.
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Affiliation(s)
- M W van Ittersum
- Research and Innovation Group in Health Care and Nursing, Hanze University Groningen, Groningen, The Netherlands.
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