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Moreno-Ligero M, Dueñas M, Failde I, Del Pino R, Coronilla MC, Moral-Munoz JA. Psychometric Properties of the Pictorial Pain Interference Questionnaire for Assessing Functional Interference in Chronic Low Back Pain. Arch Phys Med Rehabil 2024:S0003-9993(24)01049-9. [PMID: 38866224 DOI: 10.1016/j.apmr.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE To analyze the psychometric properties of the Pictorial Pain Interference Questionnaire (PPIQ) for evaluating functional interference in the population with chronic low back pain (CLBP). DESIGN Cross-sectional study. SETTING Rehabilitation Unit in a hospital. PARTICIPANTS Ninety-nine patients with CLBP. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Functional interference was assessed using PPIQ. The following data were also collected: sociodemographic data; pain intensity (Numeric Pain Rating Scale [NPRS]); physical functioning (30-s arm curl, 30-s chair stand [30CST], and timed Up and Go [TUG] tests), fitness (International Physical Activity Questionnaire); quality of life (Short-Form 12 Health Survey version 1 [SF-12v1]); sleep quality (Spanish-validated 12-item Medical Outcomes Study Sleep scale [12-MOS Sleep]); anxiety and depression (Hospital Anxiety and Depression Scale [HADS]); and social support (Duke-UNK Functional Social Support Questionnaire). Internal consistency was analyzed using Cronbach's alpha, structural validity using exploratory factor analysis (EFA), and discriminant and convergent validity using bivariate analysis. RESULTS Ninety-nine patients with CLBP were included (age [mean ± SD]: 54.37±12.44 y); women, 67.7%). The EFA extracted 2 factors: "physical function and "social and sleep," which explained 57.75% of the variance. Excellent internal consistency was observed for the overall PPIQ score (Cronbach's α=0.866). Convergent validity was observed between the PPIQ and other functional measures (ρ: 0.52 and -0.47 for the TUG and 30CST, respectively; P<.001) and with the following variables: physical and mental component summaries of the SF-12v1 (ρ: -0. 55 and -0.52, respectively (P<.001); anxiety and depression of the HADS (ρ: 0.47 and 0.59, respectively (P<.001); NPRS (ρ: 0.45; P<.001); and index 9 of the 12-MOS Sleep scale (r: 0.49; P<.001). CONCLUSIONS The PPIQ is a valid instrument with good psychometric properties for measuring functional interference in people with CLBP. This questionnaire appears to be a feasible alternative when language or communication barriers exist in CLBP population.
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Affiliation(s)
- Marta Moreno-Ligero
- Department of Biomedicine, Biotechnology and Public Health, Preventive Medicine and Public Health Area, University of Cadiz, Cadiz, Spain; Observatory of Pain, University of Cadiz, Cadiz, Spain
| | - María Dueñas
- Observatory of Pain, University of Cadiz, Cadiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cadiz, Spain; Department of Statistics and Operational Research, University of Cadiz, Cadiz, Spain.
| | - Inmaculada Failde
- Department of Biomedicine, Biotechnology and Public Health, Preventive Medicine and Public Health Area, University of Cadiz, Cadiz, Spain; Observatory of Pain, University of Cadiz, Cadiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cadiz, Spain
| | - Rogelio Del Pino
- Rehabilitation Unit of University Hospital Puerta del Mar, Cadiz, Spain
| | | | - Jose A Moral-Munoz
- Observatory of Pain, University of Cadiz, Cadiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cadiz, Spain; Department of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
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Pita-Martínez C, Justo-Cousiño LA. [Does patient communication influence kinesiophobia? A systematic review]. Rehabilitacion (Madr) 2024; 58:100837. [PMID: 38316098 DOI: 10.1016/j.rh.2024.100837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
The aim of the present systematic review was to determine the effect of communication in the health care setting on kinesiophobia. To this end, a literature search was conducted in seven databases between November 2022 and February 2023. The review was carried out following the PRISMA statement and for the analysis of methodological quality we used: PEDro Scale, Van Tulder criteria and risk of bias analysis of the Cochrane Collaboration. A total of 13 articles were included with a mean methodological quality of 7.1 out of 10. Significant results were obtained for at least one variable (kinesiophobia, disability or level of physical activity) in 12 articles. There is strong evidence that communication can influence a subject's kinesiophobia. This influence is most likely to be in a negative or disabling sense, but it can also act in a positive sense by decreasing it.
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Affiliation(s)
- C Pita-Martínez
- Unidad de Investigación en Cuidados (SERGAS Área Sanitaria de Vigo), Galicia, España; Grupo de Investigación Traslacional en Cuidados (INVESTIC), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Galicia, España
| | - L A Justo-Cousiño
- Universidade de Vigo, Facultade de Fisioterapia, Campus A Xunqueira, Galicia, España; Grupo de Investigación Fisioterapia Clínica (FS1), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Galicia, España.
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Dai W, Guo X, Cai W, Zheng Y, Chen Y, Zhu Y, Tian X. Preliminary study of the consciousness-promotion mechanism of electroacupuncture in comatose patients with diffuse axonal injuries. J Neurosurg Sci 2024; 68:186-194. [PMID: 33709661 DOI: 10.23736/s0390-5616.21.05236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Diffuse axonal injury (DAI) accounts for 30-40% of total neurotrauma cases, and the majority among them manifest with consciousness disturbance. At present, the understanding of the treatment of coma and awakening in patients with DAIs is still limited. This study is characterized by the use of electroacupuncture along with conventional Western medicine to promote consciousness more effectively in comatose patients with DAIs, shorten their time spent in a coma, and gain time for more favorable treatments during follow-up rehabilitation in order to improve the cure rate, reduce the morbidity rate, and achieve better therapeutic effects. METHODS In this randomized controlled study, 145 comatose patients with DAIs (type III) were divided into the treatment group (N.=71) and control group (N.=74). The patients in the control group were treated with conventional Western medicine, while those in the treatment group were treated with both electroacupuncture and conventional treatment. The Glasgow Coma Scale (GCS) scores and consciousness-promotion rates of both groups were observed before treatment as well as 10, 20, and 30 days after treatment. Meanwhile, serum acetylcholinesterase E (AchE) concentrations in both groups were measured with ELISA, while AchE activity was determined with the rate method. Correlations between GCS score, AchE concentration, and AchE activity in the treatment group were analyzed by using the stepwise multiple regression method. RESULTS The GCS scores in the treatment group showed significant increases after the first, second, and third courses of treatment when compared to the pre-treatment scores (P<0.05). After 1 course of treatment, the GCS scores in the control group were not statistically significantly different compared to the pre-treatment scores (P>0.05), whereas after 2 and 3 courses of treatment, the differences were of greater statistical significance (P<0.05). Statistically significant differences between the two groups were found in GCS scores in the same course of treatment (P<0.05). The consciousness-promotion rates between the two groups after the same treatment course were statistically significantly different (P<0.05). Both the standardized regression coefficients and partial correlation coefficients showed that AchE concentration had a certain influence on GCS score (|Beta|=0.3601; r Y2.1=0.726). CONCLUSIONS Conventional Western medicine combined with electroacupuncture treatment may promote the consciousness of patients with DAIs and shorten the amount of time they spend comatose. Furthermore, the neurotransmitter AchE may play a role in the pathophysiological mechanism of consciousness promotion.
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Affiliation(s)
- Weichuan Dai
- Department of Neurosurgery, Jinjiang Municipal Hospital, Jinjiang, China -
| | - Xieli Guo
- Department of Neurosurgery, Jinjiang Municipal Hospital, Jinjiang, China
| | - Wenhua Cai
- Department of Neurosurgery, Jinjiang Municipal Hospital, Jinjiang, China
| | - Yanfei Zheng
- Department of Neurosurgery, Jinjiang Municipal Hospital, Jinjiang, China
| | - Yingxian Chen
- Department of Neurosurgery, Jinjiang Municipal Hospital, Jinjiang, China
| | - Yuyan Zhu
- Department of Neurosurgery, Jinjiang Municipal Hospital, Jinjiang, China
| | - Xiayang Tian
- Department of Rehabilitation, Jinjiang Municipal Hospital, Jinjiang, China
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Lemmers GPG, Melis RJF, Pagen S, Hak R, Snoo EKD, Westert GP, van der Wees PJ, Staal JB. The association of the STarT Back Screening Tool and type of leg pain with low back pain disability trajectories: a prospective cohort study. BMC Musculoskelet Disord 2024; 25:193. [PMID: 38439000 PMCID: PMC10910701 DOI: 10.1186/s12891-024-07301-8] [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] [Received: 10/05/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Multiple factors influence the recovery process of low back pain (LBP). The identification and increased knowledge of prognostic factors might contribute to a better understanding of the course of LBP. The purpose of this study is to investigate the association of the STarT Back Screening Tool (SBST) risk score and the type of leg pain (non-radiating LBP, referred non-radicular, and radicular radiating leg pain) with the disability trajectory (at baseline, the slope, and recovery at one year) in adults with low back pain. METHODS This is a prospective cohort study in 347 patients with low back pain who sought physiotherapy care at three primary care practices in the Netherlands. Linear mixed models were estimated to describe the association of the SBST risk score and the type of leg pain with disability at baseline, the slope in the disability trajectory, and at twelve months follow-up. RESULTS A medium/high risk score on the SBST is associated with higher baseline disability scores on the Oswestry Disability Index (ODI), faster initial recovery, and still a higher disability ODI score at 12 months follow-up. Non-radicular referred and radicular radiating leg pain were associated with worse baseline disability ODI scores in LBP. This association was not present for the initial recovery or at the 12 months follow-up. CONCLUSION The SBST is associated with the LBP recovery trajectory. The SBST might be a useful tool to predict the disability trajectory in a heterogeneous group of people with low back pain in primary care and might, therefore, be recommended in future clinical practice guidelines. The type of leg pain was not associated with the recovery trajectory of LBP. Future research might focus on evaluating different types of leg pain. TRIAL REGISTRATION Clinicaltrials.gov: 109,643.
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Affiliation(s)
- Gijs P G Lemmers
- Radboud University Medical Center, IQ Health, Kapittelweg 54, Nijmegen, 6525 EP, The Netherlands.
- Dutch Healthcare Authority, Utrecht, The Netherlands.
| | - René J F Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Robin Hak
- Fysius Back Experts, Nijverdal, The Netherlands
| | | | - Gert P Westert
- Radboud University Medical Center, IQ Health, Kapittelweg 54, Nijmegen, 6525 EP, The Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, IQ Health, Kapittelweg 54, Nijmegen, 6525 EP, The Netherlands
| | - J Bart Staal
- Radboud University Medical Center, IQ Health, Kapittelweg 54, Nijmegen, 6525 EP, The Netherlands
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
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Brennan PL. Stressors and Pain across the Late-Life Span: Findings from Two Parent Longitudinal Studies of Aging and Health. J Aging Health 2023; 35:677-687. [PMID: 35658697 PMCID: PMC10478334 DOI: 10.1177/08982643221104369] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective is to determine associations between stressors and pain across the late-life span. METHOD Multilevel linear modeling was applied separately to harmonized repeated measures data from the Longitudinal Late-Life Health study (LLLH; n = 342; 13-year interval) and the Health and Retirement Study (HRS; n = 2959; 8-year interval). RESULTS In both the LLLH and HRS samples, independent of age, gender, and race, participants with higher average stressor levels experienced more numerous painful conditions and higher pain severity over the study intervals. In the HRS sample, they also experienced higher levels of pain interference. In general, participants' stressor levels did not influence rates of increase in their pain. Gender and race had few moderating effects on associations between stressors and pain. DISCUSSION Stressors and pain are associated across the late-life span. Future research should focus on the mediating mechanisms that account for this association and the moderating factors that affect its strength.
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Affiliation(s)
- Penny L. Brennan
- Institute for Health & Aging, University of California San Francisco, San Francisco, CA, USA
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Unver T, Unver B, Kacmaz KS. The test-retest reliability and minimal clinically important difference of the Dubousset Functional Test and its correlation with Rolland Morris disability questionnaire in chronic non-specific low back pain. 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 2023; 32:2086-2092. [PMID: 37119310 DOI: 10.1007/s00586-023-07720-6] [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: 12/14/2022] [Revised: 03/30/2023] [Accepted: 04/15/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE This study examines the test-retest reliability, the minimal clinically important difference (MCID), and its correlation with the Rolland Morris Disability Questionnaire (RMDQ) of the Dubousset Functional Test (DFT) in evaluating the functional capacity and dynamic balance of patients with chronic non-specific low back pain (cnsLBP). METHODS Seventy-five patients with cnsLBP aged 18 years and over were included. The Five-Repetition Sit-To-Stand Test (5R-STS), the subcomponents of the DFT (the Up and Walk Test, the Steps Test, the Down and Sitting Test, and the Dual-Tasking Test) were administered to the patients. Patients were rested for 1 h, and the DFT was applied again. Pain level was evaluated with the Visual Analogue Scale before the tests started and after the tests were completed. Self-report function assessment was made using the RMDQ. RESULTS The test-retest reliability of the subcomponents of the DFT was excellent. The ICCs were: 0.91, 0.86, 0.89, and 0.89, respectively. The standard measurement errors of the subcomponents of the DFT were 0.32, 0.12, 0.14, and 0.25, respectively. The subcomponents of the DFT were highly correlated with the RMDQ and 5R-STS with the correlation coefficients of 0,83, 0,83, 0,79, 0,83 and 0,81, 0,75, 0,73, and 0,82, respectively (p < 0.01). The MCIDs of the subcomponents were 0,60, 0,23, 0,27, and 0,48, respectively. CONCLUSION The DFT is reliable in evaluating patients' functional capacity and dynamic balance with cnsLBP without causing discomfort. It is simple, quick, and simultaneously assesses multiple areas contributing to spinal alignment, muscle integrity, and balance.
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Affiliation(s)
- Tuba Unver
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey
| | - Bayram Unver
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey
| | - Kevser Sevik Kacmaz
- Department of Physical Therapy and Rehabilitation, Izmir Katip Celebi University, TR-35340, Cigli, Izmir, Turkey.
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Slatman S, Ostelo R, van Goor H, Staal JB, Knoop J. Physiotherapy with integrated virtual reality for patients with complex chronic low back pain: protocol for a pragmatic cluster randomized controlled trial (VARIETY study). BMC Musculoskelet Disord 2023; 24:132. [PMID: 36803315 PMCID: PMC9940420 DOI: 10.1186/s12891-023-06232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) is the most common chronic pain condition worldwide. Currently, primary care physiotherapy is one of the main treatment options, but effects of this treatment are small. Virtual Reality (VR) could be an adjunct to physiotherapy care, due to its multimodal features. The primary aim of this study is to assess the (cost-)effectiveness of physiotherapy with integrated multimodal VR for patients with complex CLBP, compared to usual primary physiotherapy care. METHODS A multicenter, two-arm, cluster randomized controlled trial (RCT) including 120 patients with CLBP from 20 physiotherapists will be conducted. Patients in the control group will receive 12 weeks of usual primary physiotherapy care for CLBP. Patients in the experimental group will receive treatment consisting of 12 weeks of physiotherapy with integrated, immersive, multimodal, therapeutic VR. The therapeutic VR consists of the following modules: pain education, activation, relaxation and distraction. The primary outcome measure is physical functioning. Secondary outcome measures include pain intensity, pain-related fears, pain self-efficacy and economic measures. Effectiveness of the experimental intervention compared to the control intervention on primary and secondary outcome measures will be analyzed on an intention-to-treat principle, using linear mixed-model analyses. DISCUSSION This pragmatic, multicenter cluster randomized controlled trial, will determine the clinical and cost-effectiveness of physiotherapy with integrated, personalized, multimodal, immersive VR in favor of usual physiotherapy care for patients with CLBP. TRIAL REGISTRATION This study is prospectively registered at ClinicalTrials.gov (identifier: NCT05701891).
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Affiliation(s)
- Syl Slatman
- Research Group for Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands. .,Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands.
| | - Raymond Ostelo
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit & Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
| | - Harry van Goor
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J. Bart Staal
- grid.450078.e0000 0000 8809 2093Research Group for Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands ,grid.10417.330000 0004 0444 9382Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jesper Knoop
- grid.450078.e0000 0000 8809 2093Research Group for Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands ,grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, the Netherlands
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Virkkunen T, Husu P, Tokola K, Parkkari J, Kankaanpää M. Depressive Symptoms Are Associated With Decreased Quality of Life and Work Ability in Currently Working Health Care Workers With Recurrent Low Back Pain. J Occup Environ Med 2022; 64:782-787. [PMID: 35673261 PMCID: PMC9426739 DOI: 10.1097/jom.0000000000002586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigates the association between depressive symptoms and multisite pain and health-related quality of life and work ability in currently employed health care workers with recurrent low back pain (LBP). METHODS Multisite pain, depressive symptoms, quality of life, and work ability were assessed by validated questionnaires. A generalized linear model was used for statistical analysis. RESULTS Notably, 28% of female health care workers with LBP had at least moderate levels of depressive symptoms. Depressive symptoms were significantly associated with decreased health-related quality of life and work ability. Multisite pain was not significantly associated with work ability. CONCLUSIONS Depressive symptoms are relatively common in female health care workers with LBP, and treatment of these symptoms may be crucial to improve their work ability.
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Huang J, Xu Y, Xuan R, Baker JS, Gu Y. A Mixed Comparison of Interventions for Kinesiophobia in Individuals With Musculoskeletal Pain: Systematic Review and Network Meta-Analysis. Front Psychol 2022; 13:886015. [PMID: 35846681 PMCID: PMC9277051 DOI: 10.3389/fpsyg.2022.886015] [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] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022] Open
Abstract
Objective This systematic review aims to make a mixed comparison of interventions for kinesiophobia and individuals with musculoskeletal pain. Methods A comprehensive search strategy was conducted in the database of PubMed, MEDLINE, and Web of Science with the inclusion criteria: (1) randomized controlled design; (2) patients with musculoskeletal pain as participants; (3) treatments protocols of kinesiophobia as interventions or comparisons; (4) the score of Tampa Scale Kinesiophobia (TSK) as outcome measures. A network meta-analysis was used to synthesize the data after checking the model consistency. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Assessment Tool. Results Thirty-one studies were included in this review after a comprehensive search strategy with a low risk of bias and good consistency. According to the results of the network meta-analysis, a multi-modal treatment protocol had the highest probability to become the best choice in dealing with kinesiophobia caused by musculoskeletal pain, whereas psychological treatment protocols also showed a potentially positive effect on musculoskeletal pain-induced kinesiophobia. Conclusion Multi-modal protocols could be recommended as the preferred option when dealing with kinesiophobia caused by musculoskeletal pain. However, it is still worth mentioning that there are also potentially positive therapeutic effects of psychological interventions. Since the concept of kinesiophobia is based on the fear-avoidance model, the psychological mechanism should be paid enough attention to during treatment. Registration Number CRD42021286450.
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Affiliation(s)
- Jialu Huang
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Yining Xu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Rongrong Xuan
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Julien S. Baker
- Department of Sport and Physical Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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Davis J, Newton C, Singh G, Nolan D, O’Sullivan K. ‘Keep moving, but carefully’: back pain beliefs among NHS staff. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2022.2047781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jack Davis
- Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Christopher Newton
- Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Gurpreet Singh
- Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - David Nolan
- Graves Move More Centre, PhysioWorks, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kieran O’Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, University of Limerick, Limerick, Ireland
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Chadwick A, Frazier A, Khan TW, Young E. Understanding the Psychological, Physiological, and Genetic Factors Affecting Precision Pain Medicine: A Narrative Review. J Pain Res 2021; 14:3145-3161. [PMID: 34675643 PMCID: PMC8517910 DOI: 10.2147/jpr.s320863] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Precision pain medicine focuses on employing methods to assess each patient individually, identify their risk profile for disproportionate pain and/or the development of chronic pain, and optimize therapeutic strategies to target specific pathological processes underlying chronic pain. This review aims to provide a concise summary of the current body of knowledge regarding psychological, physiological, and genetic determinants of chronic pain related to precision pain medicine. METHODS Following the Scale for the Assessment of Narrative Review Articles (SANRA) criteria, we employed PubMed/Medline to identify relevant articles using primary database search terms to query articles such as: precision medicine, non-modifiable factors, pain, anesthesiology, quantitative sensory testing, genetics, pain medicine, and psychological. RESULTS Precision pain medicine provides an opportunity to identify populations at risk, develop personalized treatment strategies, and reduce side effects and cost through elimination of ineffective treatment strategies. As in other complex chronic health conditions, there are two broad categories that contribute to chronic pain risk: modifiable and non-modifiable patient factors. This review focuses on three primary determinants of health, representing both modifiable and non-modifiable factors, that may contribute to a patient's profile for risk of developing pain and most effective management strategies: psychological, physiological, and genetic factors. CONCLUSION Consideration of these three domains is already being integrated into patient care in other specialties, but by understanding the role they play in development and maintenance of chronic pain, we can begin to implement both precision and personalized treatment regimens.
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Affiliation(s)
- Andrea Chadwick
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andrew Frazier
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Talal W Khan
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Erin Young
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
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Rhon DI, Fritz JM, Greenlee TA, Dry KE, Mayhew RJ, Laugesen MC, Dragusin E, Teyhen DS. Move to health-a holistic approach to the management of chronic low back pain: an intervention and implementation protocol developed for a pragmatic clinical trial. J Transl Med 2021; 19:357. [PMID: 34407840 PMCID: PMC8371880 DOI: 10.1186/s12967-021-03013-y] [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] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/25/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The prevalence of chronic pain conditions is growing. Low back pain was the primary cause of disability worldwide out of 156 conditions assessed between 1990 and 2016, according to the Global Burden of Disease Study. Conventional medical approaches have failed to identify effective and long-lasting approaches for the management of chronic pain, and often fail to consider the multiple domains that influence overall health and can contribute to the pain experience. Leading international organizations that focus on pain research have stated the importance of considering these other domains within holistic and multidisciplinary frameworks for treating pain. While the research behind the theoretical link between these domains and chronic pain outcomes has expanded greatly over the last decade, there have been few practical and feasible methods to implement this type of care in normal clinical practice. METHODS The purpose of this manuscript is to describe an implementation protocol that is being used to deliver a complex holistic health intervention at multiple sites within a large government health system, as part of a larger multisite trial for patients with chronic low back pain. The Move to Health program developed by the US Army Medical Command was tailored for specific application to patients with low back pain and begins by providing an empirical link between eight different health domains (that include physical, emotional, social, and psychological constructs) and chronic low back pain. Through a six-step process, a health coach leverages motivational interviewing and information from a personal health inventory to guide the patient through a series of conversations about behavioral lifestyle choices. The patient chooses which domains they want to prioritize, and the health coach helps implement the plan with the use of SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goals and a series of resources for every domain, triaged from self-management to specialist referral. DISCUSSION Complex interventions described in clinical trials are often challenging to implement because they lack sufficient details. Implementation protocols can improve the ability to properly deliver trial interventions into regular clinical practice with increased fidelity. TRIAL REGISTRATION Implementation of this intervention protocol was developed for a clinical trial that was registered a priori (clinicaltrials.gov #NCT04172038).
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Affiliation(s)
- Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA.
- Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA.
| | | | - Tina A Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Katie E Dry
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Rachel J Mayhew
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Mary C Laugesen
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Edita Dragusin
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Deydre S Teyhen
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
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13
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Mourits BMP, Meulekamp MZ, van der Wurff P, Lucas C. Identifying prognostic factors to determine the level of recovery in servicemembers with chronic low back pain: A prospective cohort study. J Back Musculoskelet Rehabil 2021; 34:697-705. [PMID: 33896807 DOI: 10.3233/bmr-200123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The main objective of this study was to identify general and military-related factors that are associated with the level of recovery in Dutch service members with chronic low back pain (CLBP) who followed a rehabilitation program. MATERIAL AND METHOD One hundred five consecutive service members with CLBP were included in this study. The level of disability, was used to distinguish a recovered and non-recovered group. Level of pain and self-perceived recovery were used as secondary outcome measurements. Differences were evaluated within and between the groups using the Student's t-test Bivariate logistic regression analyses were used for identifying the prognostic factors related to various outcomes of recoveryRESULTS: After following the rehabilitation program, 64.8% of the service members recovered from CLBP. The recovered group, demonstrated significant effect sizes in disability and in pain The non-recovered group showed on disability a non-significant effect and in pain a significant effect. The self-perceived recovery in the recovered group was "much improved" and the non-recovered group "slightly improved". The results of the bivariate regression analyses showed no significant independent prognostic factors related to recovery. CONCLUSIONS In this study, no significant independent prognostic factors could be identified that were associated to the various outcomes of recovery in service members with CLBP who followed a rehabilitation program.
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Affiliation(s)
- B M P Mourits
- Research and Development Military Rehabilitation Centre Aardenburg, Korte Molenweg 3, The Netherlands
| | - M Z Meulekamp
- Research and Development Military Rehabilitation Centre Aardenburg, Korte Molenweg 3, The Netherlands
| | - P van der Wurff
- Research and Development Military Rehabilitation Centre Aardenburg, Korte Molenweg 3, The Netherlands.,Institute for Human Movement Studies HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - C Lucas
- Department of Clinical Epidemiology, Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam-Zuidoost, The Netherlands
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Russ DW, Amano S, Law TD, Thomas JS, Clark BC. Multiple measures of muscle function influence Sorensen Test performance in individuals with recurrent low back pain. J Back Musculoskelet Rehabil 2021; 34:139-147. [PMID: 33136088 DOI: 10.3233/bmr-200079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sorensen Test time-to-task-failure (TTF) predicts several low back pain (LBP) clinical outcomes, including recurrence. Because the test is described as a measure of trunk extensor (TE) muscle endurance, LBP rehabilitation programs often emphasize endurance training, but the direct role of TE muscle function on Sorensen Test-TTF remains unclear. OBJECTIVE To assess the discriminative and associative properties of multiple markers of isolated TE performance with regard to Sorensen Test-TTF in individuals with recurrent LBP. METHOD Secondary analysis of baseline measures from participants in a registered (NCT02308189) trial (10 men; 20 women) was performed. Participants were classified by Sorensen Test-TTF as high, moderate or low risk for subsequent LBP episodes, and compared to determine if classification could discriminate differences in TE function. Correlations between Sorensen Test-TTF and isolated TE performance, anthropometrics and disability were investigated. RESULTS Individuals at risk of subsequent LBP episodes had greater perceived disability and fat mass/TE strength ratios (P⩽ 0.05) than those not at risk. Modest, significant (r= 0.36-0.42, P⩽ 0.05) associations were found between Sorensen Test-TTF, TE endurance and fat mass/TE strength. Exploratory analyses suggested possible sex-specific differences related to Sorensen Test-TTF. CONCLUSIONS Isolated TE muscle endurance is only one of several factors with similar influence on Sorensen Test-TFF, thus LBP rehabilitation strategies should consider other factors, including TE strength, anthropometrics and perceived disability.
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Affiliation(s)
- David W Russ
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.,Division of Physical Therapy, School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, USA
| | - Shinichi Amano
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
| | - Timothy D Law
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.,Department of Family Medicine, Ohio University, Athens, OH, USA
| | - James S Thomas
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.,Division of Physical Therapy, School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, USA.,Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.,Department of Biomedical Sciences, Ohio University, Athens, OH, USA
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Prognostic factors for pain chronicity in low back pain: a systematic review. Pain Rep 2021; 6:e919. [PMID: 33981936 PMCID: PMC8108595 DOI: 10.1097/pr9.0000000000000919] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 12/19/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Several prognostic factors are related to low back pain chronicity, and these should be taken into account when planning more comprehensive models in its prevention. Low back pain is the leading cause for years lived in disability. Most people with acute low back pain improve rapidly, but 4% to 25% of patients become chronic. Since the previous systematic reviews on the subject, a large number of new studies have been conducted. The objective of this article was to review the evidence of the prognostic factors behind nonspecific chronic low back pain. A systematic literature search was performed without date limitation from the MEDLINE, Cochrane library, and Medic databases. Specific inclusion criteria were used, and risk factors before the onset of chronic symptoms were searched. Study quality was assessed by 2 independent reviewers. One hundred eleven full articles were read for potential inclusion, and 25 articles met all the inclusion criteria. One study was rated as good quality, 19 studies were rated as fair quality, and 5 articles were rated as poor quality. Higher pain intensity, higher body weight, carrying heavy loads at work, difficult working positions, and depression were the most frequently observed risk factors for chronic low back pain. Maladaptive behavior strategies, general anxiety, functional limitation during the episode, smoking, and particularly physical work were also explicitly predictive of chronicity. According to this systematic review, several prognostic factors from the biomechanical, psychological and psychosocial point of view are significant for chronicity in low back pain.
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Karartı C, Özüdoğru A, Basat HÇ, Özsoy İ, Özsoy G, Kodak Mİ, Sezgin H, Uçar İ. Determination of Biodex Balance System Cutoff Scores in Older People With Nonspecific Back Pain: A Cross-sectional Study. J Manipulative Physiol Ther 2020; 44:85-94. [PMID: 33248744 DOI: 10.1016/j.jmpt.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/19/2020] [Accepted: 07/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine cutoff scores for the Biodex Balance System (BBS) and verify if they could be used to discriminate older people with nonspecific low back pain (NSLBP) with poor postural performance from those with good postural performance. METHODS This cross-sectional study included 52 participants with NSLBP older than 65 years. One level of stability (level 5; intraclass correlation ≥0.70) and 2 conditions (eyes open and eyes closed) were selected for the testing procedure. Anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and overall stability index (OSI) scores were calculated. The participants were classified into 2 groups: high risk of falling and low risk of falling. Both the receiver operating characteristic and the area under the curve were used to determine the best BBS cutoff values. Binary logistic regression analysis was used to investigate the ability of BBS scores to predict risk of falling. RESULTS BBS cutoff scores in the eyes-open condition (APSI = 2.60, MLSI = 1.95, OSI = 2.95) and eyes-closed condition (APSI = 3.05, MLSI = 2.17, OSI = 3.25) were found to be sensitive and specific in determining postural performance. Participants with index values lower than the cutoff scores had, respectively, 6.42, 4.20, and 3.72 times lower risk of falling in the eyes-open condition and 3.33, 5.50, and 3.00 times lower risk of falling in the eyes-closed condition. The predictive characteristics of the models for risk analysis were excellent and good to excellent. CONCLUSION Our study shows that BBS cutoff scores are sensitive and specific in distinguishing between poor and good postural performance in older people with NSLBP.
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Affiliation(s)
- Caner Karartı
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey.
| | - Anıl Özüdoğru
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hakkı Çağdaş Basat
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İsmail Özsoy
- Department of Physiotherapy and Rehabilitation, Selçuk University, Konya, Turkey
| | - Gülşah Özsoy
- Department of Physiotherapy and Rehabilitation, Selçuk University, Konya, Turkey
| | - Muhammed İhsan Kodak
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hicabi Sezgin
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İlyas Uçar
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
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Brennan PL. Life Stressors: Elevations and Disparities Among Older Adults with Pain. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:2123-2136. [PMID: 32955090 PMCID: PMC7593801 DOI: 10.1093/pm/pnaa189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To examine stressor elevations among older adults with pain, and gender and race disparities in the dual burdens of late-life pain and stressors. DESIGN Cross-sectional. SETTING Community. SUBJECTS Participants in the Longitudinal Late-Life Health study (LLLH; N = 1,884) and the Health and Retirement Study (HRS; N = 7,704). METHODS Pain and stressor measures were harmonized across the LLLH and HRS samples. Analyses of covariance were conducted to determine the effects of older adults' pain, gender, race, and interactions between these factors, on their stressors in nine separate life domains, and in stressors overall. RESULTS In both the LLLH and HRS samples, older adults with painful conditions (joint, back, headache, chest pain), more numerous painful conditions, more severe pain, and more pain interference had elevated stressors in all life domains, compared with older adults without or with less serious pain. Pain was more prevalent among women and nonwhites than men and whites. Stressor exposure was higher for men than women in most life domains; it was higher for nonwhites than whites in all life domains. For certain types of pain and life domains, pain and gender, as well as pain and race, interacted to predict stressor elevations. CONCLUSIONS Late-life pain is associated with elevations in stressors, and there are gender and race disparities in the dual burdens of heightened pain and elevated stressors in later life. Pain and stressors are not consistently more strongly linked among older women than older men, or among older nonwhite than older white persons.
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Affiliation(s)
- Penny L Brennan
- Institute for Health & Aging, University of California, San Francisco, San Francisco, California, USA
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18
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Pauli J, Starkweather A, Robins JL. Screening Tools to Predict the Development of Chronic Low Back Pain: An Integrative Review of the Literature. PAIN MEDICINE 2020; 20:1651-1677. [PMID: 30307521 DOI: 10.1093/pm/pny178] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify and describe available instruments that can be used to screen patients with acute or subacute low back pain for a chronic low back pain trajectory. DESIGN Integrative literature review. METHODS An electronic search of PubMed/MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, and PsychINFO databases took place from May through July of 2014 using systematic search strategies to identify screening instruments developed to identify people at risk of chronic low back pain. After screening for inclusion and exclusion criteria as well as quality indicators, the identified studies were categorized based on whether the instrument measured psychological, clinical, or functional measures to predict chronic low back pain. RESULTS Initial searches identified 2,274 potential articles. After assessing for duplicates, title, and abstract content, there were 129 remaining articles. Articles were further excluded after analysis of the text, for a total of 42 studies reviewed. Most instruments reviewed were unable to provide evidence of predictive power for developing chronic low back pain. CONCLUSIONS This review identified numerous instruments developed to assess the likelihood of chronic low back pain in acute and subacute low back pain populations. Of the instruments reviewed, the STarT Back Screening Tool and the Örebro Musculoskeletal Pain Questionnaire demonstrated superior predictive power compared with other instruments. Both screening tools offer evidence of validation, translation into different languages and international application, and usage in various health care settings and provide data on predictive power.
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Affiliation(s)
- Jena Pauli
- Virginia Commonwealth University, School of Nursing, Richmond, Virginia
| | | | - Jo Lynne Robins
- Virginia Commonwealth University, School of Nursing, Richmond, Virginia
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Baseline Patient Characteristics Commonly Captured Before Surgery Do Not Accurately Predict Long-Term Outcomes of Lumbar Microdiscectomy Followed by Physiotherapy. Spine (Phila Pa 1976) 2020; 45:E885-E891. [PMID: 32118698 PMCID: PMC7337113 DOI: 10.1097/brs.0000000000003448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To develop and internally validate prognostic models based on commonly collected preoperative data for good and poor outcomes of lumbar microdiscectomy followed by physiotherapy. SUMMARY OF BACKGROUND DATA Lumbar microdiscectomy followed by physiotherapy is a common intervention for lumbar radiculopathy. Postoperatively, a considerable percentage of people continues to experience pain and disability. Prognostic models for recovery are scarce. METHODS We included 298 patients with lumbar radiculopathy who underwent microdiscectomy followed by physiotherapy. Primary outcomes were recovery and secondary outcomes were pain and disability at 12 months follow-up. Potential prognostic factors were selected from sociodemographic and biomedical data commonly captured preoperatively. The association between baseline characteristics and outcomes was evaluated using multivariable logistic regression analyses. RESULTS At 12 months follow-up, 75.8% of the participants met the criterion for recovery. Variables in the model for good recovery included: younger age, leg pain greater than back pain, high level of disability, and a disc herniation at another level than L3-L4. The model for poor recovery included: lower educational level, prior back surgery, and disc herniation at L3-L4. Following internal validation, the explained variance (Nagelkerke R) and area under the curve for both models were poor (≤0.02 and ≤0.60, respectively). The discriminative ability of the models for disability and pain were also poor. CONCLUSION The outcome of microdiscectomy followed by postoperative physiotherapy cannot be predicted accurately by commonly captured preoperative sociodemographic and biomedical factors. The potential value of other biomedical, personal, and external factors should be further investigated. LEVEL OF EVIDENCE 3.
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20
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Kreiner DS, Matz P, Bono CM, Cho CH, Easa JE, Ghiselli G, Ghogawala Z, Reitman CA, Resnick DK, Watters WC, Annaswamy TM, Baisden J, Bartynski WS, Bess S, Brewer RP, Cassidy RC, Cheng DS, Christie SD, Chutkan NB, Cohen BA, Dagenais S, Enix DE, Dougherty P, Golish SR, Gulur P, Hwang SW, Kilincer C, King JA, Lipson AC, Lisi AJ, Meagher RJ, O'Toole JE, Park P, Pekmezci M, Perry DR, Prasad R, Provenzano DA, Radcliff KE, Rahmathulla G, Reinsel TE, Rich RL, Robbins DS, Rosolowski KA, Sembrano JN, Sharma AK, Stout AA, Taleghani CK, Tauzell RA, Trammell T, Vorobeychik Y, Yahiro AM. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain. Spine J 2020; 20:998-1024. [PMID: 32333996 DOI: 10.1016/j.spinee.2020.04.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The North American Spine Society's (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pain. The guideline is intended to reflect contemporary treatment concepts for nonspecific low back pain as reflected in the highest quality clinical literature available on this subject as of February 2016. PURPOSE The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with nonspecific low back pain. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. STUDY DESIGN This is a guideline summary review. METHODS This guideline is the product of the Low Back Pain Work Group of NASS' Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors. RESULTS Eighty-two clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature. CONCLUSIONS The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with nonspecific low back pain. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx.
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Affiliation(s)
- D Scott Kreiner
- Barrow Neurological Institute, 4530 E. Muirwood Dr. Ste. 110, Phoenix, AZ 85048-7693, USA.
| | - Paul Matz
- Advantage Orthopedics and Neurosurgery, Casper, WY, USA
| | | | - Charles H Cho
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Zoher Ghogawala
- Lahey Hospital and Medical Center, Burlington, MA, USA; Tufts University School of Medicine, Boston, MA, USA
| | | | | | - William C Watters
- Institute of Academic Medicine Houston Methodist Hospital, Houston, TX, USA
| | - Thiru M Annaswamy
- VA North Texas Health Care System, UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Shay Bess
- Denver International Spine Center, Denver, CO, USA
| | - Randall P Brewer
- River Cities Interventional Pain Specialists, Shreveport, LA, USA
| | | | - David S Cheng
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paul Park
- University Of Michigan, Ann Arbor, MI, USA
| | | | | | - Ravi Prasad
- University of California, Davis, Sacramento, CA, USA
| | | | - Kris E Radcliff
- Rothman Institute, Thomas Jefferson University, Egg Harbor Township, NJ, USA
| | | | | | | | | | | | | | | | | | | | - Ryan A Tauzell
- Choice Physical Therapy & Wellness, Christiansburg, VA, USA
| | | | - Yakov Vorobeychik
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Amy M Yahiro
- North American Spine Society, Burr Ridge, IL, USA
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Efficacy of an integrated, active rehabilitation protocol in patients ≥ 65 years of age with chronic mechanical low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:586-595. [PMID: 31845031 DOI: 10.1007/s00586-019-06248-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/03/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE This retrospective study aimed to determine the efficacy of an integrated active, rehabilitation protocol in patients ≥ 65 years of age with chronic mechanical low back pain and compare the results in similar patients in 50-64 years age group. METHODS Pre- and post-treatment mean numerical pain rating scale (NPRS) score, mean Oswestry disability index (ODI) score, treatment outcome category and minimal clinically important difference (MCID) thresholds achieved for NPRS and ODI scores post-treatment were compared among 697 patients in the 50-64 years and 495 patients in the ≥ 65 years age groups. RESULTS At a mean treatment duration of 57 days (range, 30-90 days), both mean NPRS score (p < 0.0001) and mean ODI score (p < 0.0001) were significantly higher in the ≥ 65 years age group when compared to the 50-64 years age group. However, post-treatment outcome categories (p = 0.17) and percentage of patients who achieved MCID thresholds for NPRS score (p = 0.13) and ODI score (p = 0.18) were not significantly different between the two groups. There was a significant correlation between post-treatment NPRS score and patient age and pre-treatment NPRS score and between post-treatment ODI score and incidence of osteoporosis and pre-treatment ODI score. CONCLUSION Although mean NPRS and ODI scores achieved were significantly better in patients of 50-64 years of age, our integrated active, rehabilitation protocol helped achieve significant improvement in NPRS score, MCID thresholds for NPRS and ODI scores and treatment outcomes in patients ≥ 65 years of age, similar to patients in the 50-64 years of age group, at the end of 3 months of treatment. These slides can be retrieved under Electronic Supplementary Material.
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Verburg AC, van Dulmen SA, Kiers H, Nijhuis-van der Sanden MWG, van der Wees PJ. Development of a standard set of outcome measures for non-specific low back pain in Dutch primary care physiotherapy practices: a Delphi study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1550-1564. [PMID: 31004195 DOI: 10.1007/s00586-019-05962-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/22/2019] [Accepted: 03/24/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop a clinical standard set of outcome measures that are accepted for relevance and feasibility by stakeholders and useful for (a) interaction between patient and the professional, e.g. shared decision-making in goal-setting, monitoring and feedback based on outcomes, (b) internal quality improvement, and (c) external transparency in patients with non-specific low back pain (NSLBP) in primary care physical therapy. METHODS We used a consensus-driven modified RAND-UCLA Delphi method in seven steps with panellists (patients, representatives of patient and physiotherapy associations, researchers, policy makers, health insurers): (1) literature search, (2) first online survey, (3) patient interviews, (4) an experts meeting, (5) a consensus meeting, (6) second online survey, and (7) final approval of an advisory board. Steps 1-4 resulted in potential outcome measures. In the consensus meeting after discussion panellists voted for inclusion per measure. In the second online survey the final standard set was rated on relevance and feasibility on a 9-point Likert scale; when the median score was ≥ 7, the standard set was accepted and finally approved. RESULTS Thirteen draft outcome measures were rated and discussed, and finally, six outcome measures were accepted. The standard set includes the Quebec Back Pain Disability Scale, Oswestry Disability Index, Patient-Specific Functional Scale, Numeric Pain Rating Scale, Global Perceived Effect (GPE-DV), and the STarT Back Screening Tool (SBT). CONCLUSION This study presents a standard set of outcome measures for patients with NSLBP in primary care physiotherapy accepted for relevance and feasibility by stakeholders. The standard set is currently used in daily practice and tested on validity and reliability in a pilot study. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- A C Verburg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
| | - S A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - H Kiers
- Institute for Human Movement Studies, Utrecht University of Applied Sciences, Utrecht, The Netherlands
- Association for Quality in Physical Therapy (SKF), Zwolle, The Netherlands
| | - M W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - P J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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Meints SM, Edwards RR. Evaluating psychosocial contributions to chronic pain outcomes. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:168-182. [PMID: 29408484 PMCID: PMC6067990 DOI: 10.1016/j.pnpbp.2018.01.017] [Citation(s) in RCA: 246] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
The biopsychosocial model of pain dominates the scientific community's understanding of chronic pain. Indeed, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another. In this article, we review two categories of studies that evaluate the contributions of psychosocial factors to the experience of chronic pain. First, we consider general psychosocial variables including distress, trauma, and interpersonal factors. Additionally, we discuss pain-specific psychosocial variables including catastrophizing, expectations, and pain-related coping. Together, we present a diverse array of psychological, social, and contextual factors and highlight the need to consider their roles in the development, maintenance, and treatment of chronic pain conditions.
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Affiliation(s)
- S M Meints
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA.
| | - R R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
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Steele J, Fisher J, Perrin C, Conway R, Bruce-Low S, Smith D. Does change in isolated lumbar extensor muscle function correlate with good clinical outcome? A secondary analysis of data on change in isolated lumbar extension strength, pain, and disability in chronic low back pain. Disabil Rehabil 2018; 41:1287-1295. [DOI: 10.1080/09638288.2018.1424952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- James Steele
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - James Fisher
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - Craig Perrin
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - Rebecca Conway
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - Stewart Bruce-Low
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - Dave Smith
- Department of Exercise and Sport Science, Manchester Metropolitan University, Manchester, UK
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Juntakarn C, Prasartritha T, Petrakard P. The Effectiveness of Thai Massage and Joint Mobilization. Int J Ther Massage Bodywork 2017; 10:3-8. [PMID: 28690703 PMCID: PMC5495387 DOI: 10.3822/ijtmb.v10i2.350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Non-specific low back pain (LBP) is a common health problem resulting from many risk factors and human behaviors. Some of these may interact synergistically and have been implicated in the cause of low back pain. Massage both traditional Thai massage and joint mobilization as a common practice has been shown to be effective for some subgroup of nonspecific LBP patients. PURPOSE AND SETTING The trial compared the effectiveness between traditional Thai massage and joint mobilization for treating nonspecific LBP. Some associated factors were included. The study was conducted at the orthopedic outpatient department, Lerdsin General Hospital, Bangkok, Thailand. METHODS Prospective, randomized study was developed without control group. The required sample size was estimated based on previous comparative studies for effectiveness between techniques. Two primary outcome measures were a 0 to 10 visual analog scale (VAS) of pain and Oswestry Disability Index (ODI). Secondary outcome measures were satisfaction of patients and adverse effects of the treatment. The "intention to treat" (ITT) and per protocol approach were used to compare the significance of the difference between treatment groups. PARTICIPANTS One hundred and twenty hospital outpatients, 20 (16.7%) male and 100 (83.3%) female, were randomized into traditional Thai massage and joint mobilization therapy. The average age of traditional Thai massage and joint mobilization was 50.7 years and 48.3 years, respectively. Both groups received each treatment for approximately 30 minutes twice per week over a four-week period. Total course did not exceed eight sessions. RESULT With ITT, the mean VAS of traditional Thai massage group before treatment was 5.3 (SD = 1.7) and ODI was 24.9 (SD = 14.7), while in joint mobilization groups, the mean VAS was 5.0 (SD = 1.6) and ODI was 24.6 (SD = 15). After treatment, the mean VAS and ODI were significantly reduced (VAS = 0.51 (SD = 0.89) and ODI = 8.1 (SD = 10.7) for traditional Thai massage, VAS = 0.86 (SD = 1.49) and ODI = 8.26 (SD = 12.97) for joint mobilization). Constipation was found in 34 patients (28.3%). CONCLUSION The traditional Thai massage and joint mobilization used in this study were equally effective for short-term reduction of pain and disability in patients with chronic nonspecific LBP. Both techniques were safe with short term effect in a chosen group of patients.
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Affiliation(s)
| | | | - Prapoj Petrakard
- Department of Thai Traditional and Alternative Medicine, Ministry of Public Health, Nonthaburi, Thailand
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Carvalho FA, Maher CG, Franco MR, Morelhão PK, Oliveira CB, Silva FG, Pinto RZ. Fear of Movement Is Not Associated With Objective and Subjective Physical Activity Levels in Chronic Nonspecific Low Back Pain. Arch Phys Med Rehabil 2016; 98:96-104. [PMID: 27713076 DOI: 10.1016/j.apmr.2016.09.115] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/12/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the association of physical activity measures, derived with an accelerometer and a self-reported questionnaire, with fear of movement in patients with chronic nonspecific low back pain (LBP) and to investigate the association between disability and fear of movement in this population. DESIGN Cross-sectional study. SETTING Outpatient physical therapy university clinics. PARTICIPANTS Patients (N=119) presenting with nonspecific LBP of >3 months' duration. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Physical activity levels measured objectively with an accelerometer (ie, counts per minute, time spent in moderate-to-vigorous and light physical activity per day, number of steps per day, and number of 10-minute bouts of moderate-to-vigorous physical activity per day) and subjectively with a self-reported questionnaire (Baecke Physical Activity Questionnaire); fear of movement (Tampa Scale of Kinesiophobia); pain (11-point numerical rating scale); disability (Roland Morris Disability Questionnaire); and depression (Beck Depression Inventory). The associations were examined with correlational, univariate, and multivariable linear regression analyses. RESULTS None of the objective physical activity measures were associated with fear of movement. The apparent association of self-reported physical activity levels with fear of movement (correlational analyses: r=-.18; P<.05; univariate regression analyses: β=-.04; 95% confidence interval [CI], -.07 to -.01; P=.04) was not confirmed in multivariable analyses. Fear of movement was consistently associated with disability in both correlational (r=.42; P<.01) and multivariable (β=.21; 95% CI, .11-.31; P<.001) analyses. CONCLUSIONS Our data support one aspect of the fear-avoidance model-that higher fear of movement is associated with more disability-but not the aspect of the model linking fear of movement with inactivity.
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Affiliation(s)
- Flávia A Carvalho
- Physical Therapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, Brazil
| | - Chris G Maher
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Marcia R Franco
- Physical Therapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, Brazil
| | - Priscila K Morelhão
- Physical Therapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, Brazil
| | - Crystian B Oliveira
- Physical Therapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, Brazil
| | - Fernanda G Silva
- Physical Therapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, Brazil
| | - Rafael Z Pinto
- Physical Therapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, Brazil; Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
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Edwards RR, Dworkin RH, Sullivan MD, Turk DC, Wasan AD. The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain. THE JOURNAL OF PAIN 2016; 17:T70-92. [PMID: 27586832 PMCID: PMC5012303 DOI: 10.1016/j.jpain.2016.01.001] [Citation(s) in RCA: 476] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/07/2015] [Accepted: 01/05/2016] [Indexed: 12/14/2022]
Abstract
UNLABELLED The recently proposed Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION)-American Pain Society (APS) Pain Taxonomy (AAPT) provides an evidence-based, multidimensional, chronic pain classification system. Psychosocial factors play a crucial role within several dimensions of the taxonomy. In this article, we discuss the evaluation of psychosocial factors that influence the diagnosis and trajectory of chronic pain disorders. We review studies in individuals with a variety of persistent pain conditions, and describe evidence that psychosocial variables play key roles in conferring risk for the development of pain, in shaping long-term pain-related adjustment, and in modulating pain treatment outcomes. We consider "general" psychosocial variables such as negative affect, childhood trauma, and social support, as well as "pain-specific" psychosocial variables that include pain-related catastrophizing, self-efficacy for managing pain, and pain-related coping. Collectively, the complexity and profound variability in chronic pain highlights the need to better understand the multidimensional array of interacting forces that determine the trajectory of chronic pain conditions. PERSPECTIVE The AAPT is an evidence-based chronic pain classification system in which psychosocial concepts and processes are essential in understanding the development of chronic pain and its effects. In this article we review psychosocial processes that influence the onset, exacerbation, and maintenance of chronic pain disorders.
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Affiliation(s)
- Robert R Edwards
- Department of Anesthesiology, Brigham & Women's Hospital and Harvard University, Boston, Massachusetts.
| | - Robert H Dworkin
- Departments of Anesthesiology and Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Ajay D Wasan
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Trocoli TO, Botelho RV. Prevalence of anxiety, depression and kinesiophobia in patients with low back pain and their association with the symptoms of low back spinal pain. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:330-6. [PMID: 27476626 DOI: 10.1016/j.rbre.2016.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/03/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of anxiety, depression and kinesiophobia and their association with the symptoms of low back pain. METHODS A total of 65 patients were divided into three groups: Organic, Amplified Organic and Non-Organic. They answered the Beck Anxiety Inventory, Beck Depression Inventory and Tampa Scale of Kinesiophobia and were evaluated according to their pain level using the Visual Analogic Scale. RESULTS The average kinesiophobia scores of the patients in the Organic, Amplified Organic and Non-Organic groups were 36.26, 36.21 and 23.06 points, respectively. Patients who were classified into the Organic group experienced the most kinesiophobia out of all three groups (p=0.007). The average anxiety scores of the patients in the Organic, Amplified Organic and Non-Organic groups were 33.17, 32.79 and 32.81 points, respectively, with no significant difference among the groups (p=0.99). The average depression scores of the patients in the Organic, Amplified Organic and Non-Organic groups were 32.54, 28.79 and 37.69 points, respectively, with no significant difference among the groups (p=0.29). CONCLUSION There was no association between the groups and anxiety and depression. However, there was a positive correlation between kinesiophobia and the Organic group. Studies of other patient samples are needed to confirm the reproducibility and validity of these data in other populations.
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Affiliation(s)
- Tathiana O Trocoli
- Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo (IAMSPE), São Paulo, SP, Brazil.
| | - Ricardo V Botelho
- Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo (IAMSPE), São Paulo, SP, Brazil
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Trocoli TO, Botelho RV. Prevalence of anxiety, depression and kinesiophobia in patients with low back pain and their association with the symptoms of low back spinal pain. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:S0482-5004(16)00023-1. [PMID: 26952872 DOI: 10.1016/j.rbr.2015.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/10/2015] [Accepted: 09/03/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of anxiety, depression and kinesiophobia and their association with the symptoms of low back pain. METHODS A total of 65 patients were divided into three groups: Organic, Amplified Organic and Non-Organic. They answered the Beck Anxiety Inventory, Beck Depression Inventory and Tampa Scale of Kinesiophobia and were evaluated according to their pain level using the Visual Analogic Scale. RESULTS The average kinesiophobia scores of the patients in the Organic, Amplified Organic and Non-Organic groups were 36.26, 36.21 and 23.06 points, respectively. Patients who were classified into the Organic group experienced the most kinesiophobia out of all 3 groups (p=0.007). The average anxiety scores of the patients in the Organic, Amplified Organic and Non-Organic groups were 33.17, 32.79 and 32.81 points, respectively, with no significant difference among the groups (p=0.99). The average depression scores of the patients in the Organic, Amplified Organic and Non-Organic groups were 32.54, 28.79 and 37.69 points, respectively, with no significant difference among the groups (p=0.29). CONCLUSION There was no association between the groups and anxiety and depression. However, there was a positive correlation between kinesiophobia and the Organic group. Studies of other patient samples are needed to confirm the reproducibility and validity of these data in other populations.
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Affiliation(s)
- Tathiana O Trocoli
- Departamento de Neurocirurgia do Hospital do Servidor Público Estadual de São Paulo (Iamspe), São Paulo, SP, Brasil.
| | - Ricardo V Botelho
- Departamento de Neurocirurgia do Hospital do Servidor Público Estadual de São Paulo (Iamspe), São Paulo, SP, Brasil
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Froud R, Bjørkli T, Bright P, Rajendran D, Buchbinder R, Underwood M, Evans D, Eldridge S. The effect of journal impact factor, reporting conflicts, and reporting funding sources, on standardized effect sizes in back pain trials: a systematic review and meta-regression. BMC Musculoskelet Disord 2015; 16:370. [PMID: 26620449 PMCID: PMC4663726 DOI: 10.1186/s12891-015-0825-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain is a common and costly health complaint for which there are several moderately effective treatments. In some fields there is evidence that funder and financial conflicts are associated with trial outcomes. It is not clear whether effect sizes in back pain trials relate to journal impact factor, reporting conflicts of interest, or reporting funding. METHODS We performed a systematic review of English-language papers reporting randomised controlled trials of treatments for non-specific low back pain, published between 2006-2012. We modelled the relationship using 5-year journal impact factor, and categories of reported of conflicts of interest, and categories of reported funding (reported none and reported some, compared to not reporting these) using meta-regression, adjusting for sample size, and publication year. We also considered whether impact factor could be predicted by the direction of outcome, or trial sample size. RESULTS We could abstract data to calculate effect size in 99 of 146 trials that met our inclusion criteria. Effect size is not associated with impact factor, reporting of funding source, or reporting of conflicts of interest. However, explicitly reporting 'no trial funding' is strongly associated with larger absolute values of effect size (adjusted β=1.02 (95 % CI 0.44 to 1.59), P=0.001). Impact factor increases by 0.008 (0.004 to 0.012) per unit increase in trial sample size (P<0.001), but does not differ by reported direction of the LBP trial outcome (P=0.270). CONCLUSIONS The absence of associations between effect size and impact factor, reporting sources of funding, and conflicts of interest reflects positively on research and publisher conduct in the field. Strong evidence of a large association between absolute magnitude of effect size and explicit reporting of 'no funding' suggests authors of unfunded trials are likely to report larger effect sizes, notwithstanding direction. This could relate in part to quality, resources, and/or how pragmatic a trial is.
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Affiliation(s)
- Robert Froud
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
- Norge Helsehøyskole,, Campus Kristiania, Prinsens Gate 7-9, 0152, Oslo, Norway.
| | - Tom Bjørkli
- Norge Helsehøyskole,, Campus Kristiania, Prinsens Gate 7-9, 0152, Oslo, Norway.
| | - Philip Bright
- European School of Osteopathy, The Street, ME14 3DZ Boxley, Maidstone, UK.
| | - Dévan Rajendran
- Norge Helsehøyskole,, Campus Kristiania, Prinsens Gate 7-9, 0152, Oslo, Norway.
- European School of Osteopathy, The Street, ME14 3DZ Boxley, Maidstone, UK.
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, Monash University, Suite 41, Cabrini Medical Centre, 183 Wattletree Road, Malvern, 3144, Melbourne, Victoria, Australia.
| | - Martin Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
| | - David Evans
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
- Norge Helsehøyskole,, Campus Kristiania, Prinsens Gate 7-9, 0152, Oslo, Norway.
| | - Sandra Eldridge
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB Whitechapel, UK.
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Verkerk K, Luijsterburg PAJ, Heymans MW, Ronchetti I, Pool-Goudzwaard AL, Miedema HS, Koes BW. Prognosis and course of pain in patients with chronic non-specific low back pain: A 1-year follow-up cohort study. Eur J Pain 2015; 19:1101-10. [PMID: 25565501 DOI: 10.1002/ejp.633] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND It remains unclear to what extent patients recover from chronic non-specific low back pain (NSLBP). The objective of this study was to determine (1) the course of chronic NSLBP in tertiary care and (2) which factors predicted 5- and 12-month outcomes. METHODS This prospective study includes 1760 chronic NSLBP patients from a rehabilitation clinic (mean age 40.1 years, SD 10.6). After baseline measurement, patients followed a 2-month multidisciplinary therapy programme; evaluation took place at 2, 5 and 12 months post baseline. Recovery was defined as (1) relative recovery [30% improvement on the pain, visual analogue scale (VAS) compared with baseline] and (2) absolute recovery (VAS pain ≤ 10 mm). The multivariate logistic regression analysis included 23 baseline characteristics. RESULTS Patient-reported intensity of back pain decreased from 55.5 (SD 23.0) at baseline to 37.0 (SD 23.8), 35.3 (SD 26.1) and 32.3 (SD 26.9) at 2-, 5- and 12-month follow-up, respectively. Younger age, back pain at baseline, no psychological/physical dysfunction (Symptom Check List-90, item 9), and higher baseline scores on the physical component scale and mental component scale of quality of life (Short Form-36) were positively associated with recovery at 5 and 12 months. At 5-month follow-up, higher work participation at baseline was also a prognostic factor for both definitions of recovery. At 12-month follow-up, having co-morbidity was predictive for both definitions. CONCLUSION The results of this study indicate that in chronic NSLBP patients, bio-psychosocial prognostic factors may be important for clinicians when predicting recovery in back pain intensity during a 1-year period.
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Affiliation(s)
- K Verkerk
- Rotterdam University of Applied Sciences, The Netherlands.,Spine & Joint Centre, Rotterdam, The Netherlands.,Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - P A J Luijsterburg
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M W Heymans
- EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Methodology and Applied Biostatistics, Institute for Health Sciences, VU University, Amsterdam, The Netherlands.,Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - I Ronchetti
- Spine & Joint Centre, Rotterdam, The Netherlands
| | - A L Pool-Goudzwaard
- Department of Neuroscience, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - H S Miedema
- Rotterdam University of Applied Sciences, The Netherlands
| | - B W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Shaw WS, Kristman VL, Williams-Whitt K, Soklaridis S, Huang YH, Côté P, Loisel P. The Job Accommodation Scale (JAS): psychometric evaluation of a new measure of employer support for temporary job modifications. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:755-65. [PMID: 24643785 PMCID: PMC4465389 DOI: 10.1007/s10926-014-9508-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION An employer offer of temporary job modification is a key strategy for facilitating return-to-work for musculoskeletal conditions, but there are no validated scales to assess the level of support for temporary job modifications across a range of job types and organizations. OBJECTIVE To pilot test a new 21-item self-report measure [the Job Accommodation Scale (JAS)] to assess its applicability, internal consistency, factor structure, and relation to physical job demands. METHODS Supervisors (N = 804, 72.8 % male, mean age = 46) were recruited from 19 employment settings in the USA and Canada and completed a 30-min online survey regarding job modification practices. As part of the survey, supervisors nominated and described a job position they supervised and completed the JAS for a hypothetical worker (in that position) with an episode of low back pain. Job characteristics were derived from the occupational informational network job classification database. RESULTS The full response range (1-4) was utilized on all 21 items, with no ceiling or floor effects. Avoiding awkward postures was the most feasible accommodation and moving the employee to a different site or location was the least feasible. An exploratory factor analysis suggested five underlying factors (Modify physical workload; Modify work environment; Modify work schedule; Find alternate work; and Arrange for assistance), and there was an acceptable goodness-of-fit for the five parceled sub-factor scores as a single latent construct in a measurement model (structural equation model). Job accommodations were less feasible for more physical jobs and for heavier industries. CONCLUSIONS The pilot administration of the JAS with respect to a hypothetical worker with low back pain showed initial support for its applicability, reliability, and validity when administered to supervisors. Future studies should assess its validity for use in actual disability cases, for a range of health conditions, and to assess different stakeholder opinions about the feasibility of job accommodation strategies.
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Affiliation(s)
- William S Shaw
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA,
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Royuela A, Kovacs FM, Campillo C, Casamitjana M, Muriel A, Abraira V. Predicting outcomes of neuroreflexotherapy in patients with subacute or chronic neck or low back pain. Spine J 2014; 14:1588-600. [PMID: 24345468 DOI: 10.1016/j.spinee.2013.09.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 08/27/2013] [Accepted: 09/19/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In the context of shared decision-making, a valid estimation of the probability that a given patient will improve after a specific treatment is valuable. PURPOSE To develop models that predict the improvement of spinal pain, referred pain, and disability in patients with subacute or chronic neck or low back pain undergoing a conservative treatment. STUDY DESIGN AND SETTING Analysis of data from a prospective registry in routine practice. PATIENT SAMPLE All patients who had been discharged after receiving a conservative treatment within the Spanish National Health Service (SNHS) (n=8,778). OUTCOME MEASURES Spinal pain, referred pain, and disability were assessed before the conservative treatment and at discharge by the use of previously validated methods. METHODS Improvement in spinal pain, referred pain, and disability was defined as a reduction in score greater than the minimal clinically important change. A predictive model that included demographic, clinical, and work-related variables was developed for each outcome using multivariate logistic regression. Missing data were addressed using multiple imputation. Discrimination and calibration were assessed for each model. The models were validated by bootstrap, and nomograms were developed. RESULTS The following variables showed a predictive value in the three models: baseline scores for pain and disability, pain duration, having undergone X-ray, having undergone spine surgery, and receiving financial assistance for neck or low back pain. Discrimination of the three models ranged from slight to moderate, and calibration was good. CONCLUSIONS A registry in routine practice can be used to develop models that estimate the probability of improvement for each individual patient undergoing a specific form of treatment. Generalizing this approach to other treatments can be valuable for shared decision making.
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Affiliation(s)
- Ana Royuela
- CIBER Epidemiología y Salud Pública (CIBERESP), C/ Melchor Fernandez Almagro 3-5, 28029 Madrid, Spain; Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRICYS, C/ Colmenar Viejo, 9, 28031 Madrid, Spain; Spanish Back Pain Research Network, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain.
| | - Francisco M Kovacs
- Spanish Back Pain Research Network, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Departamento Cientıfico, Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain
| | - Carlos Campillo
- Servei de Salut de les Illes Balears (Ib-Salut), Calle Reina Esclaramunda 9, 07003 Palma de Majorca, Spain
| | - Montserrat Casamitjana
- Regió Sanitària de Barcelona
- Consorci Sanitari de Barcelona, Servei Català de la Salut (CatSalut), Parc Sanitari Pere Virgili - Edifici Mestral - Esteve Terradas, 30 4ta planta, 08023 Barcelona, Spain
| | - Alfonso Muriel
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRICYS, C/ Colmenar Viejo, 9, 28031 Madrid, Spain; Spanish Back Pain Research Network, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain
| | - Víctor Abraira
- CIBER Epidemiología y Salud Pública (CIBERESP), C/ Melchor Fernandez Almagro 3-5, 28029 Madrid, Spain; Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRICYS, C/ Colmenar Viejo, 9, 28031 Madrid, Spain; Spanish Back Pain Research Network, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain
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Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J 2014; 14:816-36.e4. [PMID: 24412032 DOI: 10.1016/j.spinee.2013.09.036] [Citation(s) in RCA: 288] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 07/16/2013] [Accepted: 09/19/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Psychological factors including fear avoidance beliefs are believed to influence the development of chronic low back pain (LBP). PURPOSE The purpose of this study was to determine the prognostic importance of fear avoidance beliefs as assessed by the Fear Avoidance Beliefs Questionnaire (FABQ) and the Tampa Scale of Kinesiophobia for clinically relevant outcomes in patients with nonspecific LBP. DESIGN/SETTING The design of this study was a systematic review. METHODS In October 2011, the following databases were searched: BIOSIS, CINAHL, Cochrane Library, Embase, OTSeeker, PeDRO, PsycInfo, PubMed/Medline, Scopus, and Web of Science. To ensure the completeness of the search, a hand search and a search of bibliographies was conducted and all relevant references included. A total of 2,031 references were retrieved, leaving 566 references after the removal of duplicates. For 53 references, the full-text was assessed and, finally, 21 studies were included in the analysis. RESULTS The most convincing evidence was found supporting fear avoidance beliefs to be a prognostic factor for work-related outcomes in patients with subacute LBP (ie, 4 weeks-3 months of LBP). Four cohort studies, conducted by disability insurance companies in the United States, Canada, and Belgium, included 258 to 1,068 patients mostly with nonspecific LBP. These researchers found an increased risk for work-related outcomes (not returning to work, sick days) with elevated FABQ scores. The odds ratio (OR) ranged from 1.05 (95% confidence interval [CI] 1.02-1.09) to 4.64 (95% CI, 1.57-13.71). The highest OR was found when applying a high cutoff for FABQ Work subscale scores. This may indicate that the use of cutoff values increases the likelihood of positive findings. This issue requires further study. Fear avoidance beliefs in very acute LBP (<2 weeks) and chronic LBP (>3 months) was mostly not predictive. CONCLUSIONS Evidence suggests that fear avoidance beliefs are prognostic for poor outcome in subacute LBP, and thus early treatment, including interventions to reduce fear avoidance beliefs, may avoid delayed recovery and chronicity.
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Affiliation(s)
- Maria M Wertli
- Occupational and Industrial Orthopaedic Center (OIOC), NYU Hospital for Joint Diseases, New York University, 63 Downing St, New York, NY 10014, USA; Department of Internal Medicine, Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland.
| | - Eva Rasmussen-Barr
- Occupational and Industrial Orthopaedic Center (OIOC), NYU Hospital for Joint Diseases, New York University, 63 Downing St, New York, NY 10014, USA; Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177 Stockholm, Sweden
| | - Sherri Weiser
- Occupational and Industrial Orthopaedic Center (OIOC), NYU Hospital for Joint Diseases, New York University, 63 Downing St, New York, NY 10014, USA
| | - Lucas M Bachmann
- Department of Internal Medicine, Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland
| | - Florian Brunner
- Department of Internal Medicine, Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland; Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
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Prognosis and course of disability in patients with chronic nonspecific low back pain: a 5- and 12-month follow-up cohort study. Phys Ther 2013; 93:1603-14. [PMID: 23824781 DOI: 10.2522/ptj.20130076] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Few data are available on the course of and predictors for disability in patients with chronic nonspecific low back pain (CNSLBP). OBJECTIVE The purpose of this study was to describe the course of disability and identify clinically important prognostic factors of low-back-pain-specific disability in patients with CNSLBP receiving multidisciplinary therapy. DESIGN A prospective cohort study was conducted. METHODS A total of 1,760 patients with CNSLBP who received multidisciplinary therapy were evaluated for their course of disability and prognostic factors at baseline and at 2-, 5-, and 12-month follow-ups. Recovery was defined as 30% reduction in low back pain-specific disability at follow-up compared with baseline and as absolute recovery if the score on the Quebec Back Pain Disability Scale (QBPDS) was ≤20 points at follow-up. Potential prognostic factors were identified using multivariable logistic regression analysis. RESULTS Mean patient-reported disability scores on the QBPDS ranged from 51.7 (SD=15.6) at baseline to 31.7 (SD=15.2), 31.1 (SD=18.2), and 29.1 (SD=20.0) at 2, 5, and 12 months, respectively. The prognostic factors identified for recovery at 5 and 12 months were younger age and high scores on disability and on the 36-Item Short-Form Health Survey (SF-36) (Physical and Mental Component Summaries) at baseline. In addition, at 5-month follow-up, a shorter duration of complaints was a positive predictor, and having no comorbidity and less pain at baseline were additional predictors at 12-month follow-up. LIMITATIONS Missing values at 5- and 12-month follow-ups were 11.1% and 45.2%, respectively. CONCLUSION After multidisciplinary treatment, the course of disability in patients with CNSLBP continued to decline over a 12-month period. At 5- and 12-month follow-ups, prognostic factors were identified for a clinically relevant decrease in disability scores on the QBPDS.
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Shaw WS, Campbell P, Nelson CC, Main CJ, Linton SJ. Effects of workplace, family and cultural influences on low back pain: What opportunities exist to address social factors in general consultations? Best Pract Res Clin Rheumatol 2013; 27:637-48. [DOI: 10.1016/j.berh.2013.09.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Miyamoto GC, Costa LOP, Galvanin T, Cabral CMN. The efficacy of the addition of the Pilates method over a minimal intervention in the treatment of chronic nonspecific low back pain: a study protocol of a randomized controlled trial. J Chiropr Med 2013; 10:248-54. [PMID: 22654682 DOI: 10.1016/j.jcm.2011.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 05/02/2011] [Accepted: 06/21/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE There is little high-quality evidence on the efficacy of the Pilates-based exercises for the treatment of chronic nonspecific low back pain. Therefore, the objective of this paper is to present a study protocol to investigate the efficacy of adding Pilates-based exercises to a minimum intervention in patients with chronic non-specific low back pain. METHODS This randomized controlled trial will recruit 86 patients of both sexes, aged between 18 and 60 years, with chronic non-specific low back pain. The participants will be randomly allocated into 2 treatment groups: the Booklet Group, which will receive a booklet with postural orientations, and the Pilates Group, which will receive the same booklet in addition to a Pilates-based exercises program. The general and specific functional capacities of the patient, kinesiophobia, pain intensity, and the global perceived effect will be evaluated by a blinded assessor before randomization and at 6 weeks and 6 months after randomization. In addition, the expectations of the participants and their confidence in the treatment will be evaluated before the randomization and after the first treatment session, respectively. CONCLUSIONS It is hoped that the results of this study will provide high-quality evidence on the usefulness of Pilates-based exercises in the treatment of chronic non-specific low back pain.
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Haugen AJ, Brox JI, Grøvle L, Keller A, Natvig B, Soldal D, Grotle M. Prognostic factors for non-success in patients with sciatica and disc herniation. BMC Musculoskelet Disord 2012; 13:183. [PMID: 22999108 PMCID: PMC3495213 DOI: 10.1186/1471-2474-13-183] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 09/19/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Few studies have investigated prognostic factors for patients with sciatica, especially for patients treated without surgery. The aim of this study was to identify factors associated with non-success after 1 and 2 years of follow-up and to test the prognostic value of surgical treatment for sciatica. METHODS The study was a prospective multicentre observational study including 466 patients with sciatica and lumbar disc herniation. Potential prognostic factors were sociodemographic characteristics, back pain history, kinesiophobia, emotional distress, pain, comorbidity and clinical examination findings. Study participation did not alter treatment considerations for the patients in the clinics. Patients reported on the questionnaires if surgery of the disc herniation had been performed. Uni- and multivariate logistic regression analyses were used to evaluate factors associated with non-success, defined as Maine-Seattle Back Questionnaire score of ≥5 (0-12) (primary outcome) and Sciatica Bothersomeness Index ≥7 (0-24) (secondary outcome). RESULTS Rates of non-success were at 1 and 2 years 44% and 39% for the main outcome and 47% and 42% for the secondary outcome. Approximately 1/3 of the patients were treated surgically. For the main outcome variable, in the final multivariate model non-success at 1 year was significantly associated with being male (OR 1.70 [95% CI; 1.06 - 2.73]), smoker (2.06 [1.31 - 3.25]), more back pain (1.0 [1.01 - 1.02]), more comorbid subjective health complaints (1.09 [1.03 - 1.15]), reduced tendon reflex (1.62 [1.03 - 2.56]), and not treated surgically (2.97 [1.75 - 5.04]). Further, factors significantly associated with non-success at 2 years were duration of back problems >; 1 year (1.92 [1.11 - 3.32]), duration of sciatica >; 3 months (2.30 [1.40 - 3.80]), more comorbid subjective health complaints (1.10 [1.03 - 1.17]) and kinesiophobia (1.04 [1.00 - 1.08]). For the secondary outcome variable, in the final multivariate model, more comorbid subjective health complaints, more back pain, muscular weakness at clinical examination, and not treated surgically, were independent prognostic factors for non-success at both 1 and 2 years. CONCLUSIONS The results indicate that the prognosis for sciatica referred to secondary care is not that good and only slightly better after surgery and that comorbidity should be assessed in patients with sciatica. This calls for a broader assessment of patients with sciatica than the traditional clinical assessment in which mainly the physical symptoms and signs are investigated.
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Abstract
BACKGROUND Few data are available on predictors for a favorable outcome in patients with chronic nonspecific low back pain (CNLBP). PURPOSE The aim of this study was to assess prognostic factors for pain intensity, disability, return to work, quality of life, and global perceived effect in patients with CNLBP at short-term (≤ 6 months) and long-term (>6 months) follow-up. DATA SOURCES Relevant studies evaluating the prognosis of CNLBP were searched in PubMed, CINAHL, and EMBASE (through March 2010). Study Selection Articles with all types of study designs were included. Inclusion criteria were: participants were patients with CNLBP (≥ 12 weeks' duration), participants were older than 18 years of age, and the study was related to prognostic factors for recovery. Fourteen studies met the inclusion criteria. DATA EXTRACTION Two reviewers extracted the data and details of each study. DATA SYNTHESIS A qualitative analysis using "level of evidence" was performed for all included studies. Data were summarized in tables and critically appraised. LIMITATIONS The results of the studies reviewed were limited by their methodological weaknesses. CONCLUSIONS At short-term follow-up, no association was found for the factors of age and sex with the outcomes of pain intensity and disability. At long-term follow-up, smoking had the same result. At long-term follow-up, pain intensity and fear of movement had no association with disability. At short-term follow-up, conflicting evidence was found for the association between the outcomes pain intensity and disability and the factor of fear of movement. At long-term follow-up, conflicting evidence was found for the factors of age, sex, and physical job demands. At long-term follow-up, conflicting evidence also was found for the association between return to work and age, sex, and activities of daily living. At baseline, there was limited evidence of a positive influence of lower pain intensity and physical job demands on return to work. No high-quality studies were found for the outcomes of quality of life and global perceived effect.
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Campbell P, Wynne-Jones G, Muller S, Dunn KM. The influence of employment social support for risk and prognosis in nonspecific back pain: a systematic review and critical synthesis. Int Arch Occup Environ Health 2012; 86:119-37. [PMID: 22875173 PMCID: PMC3555241 DOI: 10.1007/s00420-012-0804-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 07/24/2012] [Indexed: 12/02/2022]
Abstract
Purpose To examine the influence of employment social support type (e.g. co-worker, supervisor, general support) on risk of occurrence of low back pain, and prognosis (e.g. recovery, return to work status) for those who have low back pain. Methods Systematic search of seven databases (MEDLINE, Embase, PsychINFO, CINAHL, IBSS, AMED and BNI) for prospective or case–control studies reporting findings on employment social support in populations with nonspecific back pain. Data extraction and quality assessment were carried out on included studies. A systematic critical synthesis was carried out on extracted data. Results Thirty-two articles were included that describe 46 findings on the effect of employment social support on risk of and prognosis of back pain. Findings show that there is no effect of co-worker, supervisor or general work support on risk of new onset back pain. Weak effects of employment support were found for recovery and return to work outcomes; greater levels of co-worker support and general work support were found to be associated with less time to recovery or return to work. Conclusions The evidence suggests that the association between employment support and prognosis may be subject to influence from wider concepts related to the employment context. This review discusses these wider issues and offers directions for future research.
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Affiliation(s)
- Paul Campbell
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK.
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Rolli Salathe C, Melloh M, Mannion AF, Tamcan O, Muller U, N. B, A. E. Resources for preventing sickness absence due to low back pain. Occup Med (Lond) 2012; 62:273-80. [DOI: 10.1093/occmed/kqs024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The efficacy of targeted interventions for modifiable psychosocial risk factors of persistent nonspecific low back pain - a systematic review. ACTA ACUST UNITED AC 2012; 17:385-401. [PMID: 22421188 DOI: 10.1016/j.math.2012.02.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/16/2012] [Accepted: 02/14/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is considerable interest in whether best practice management of nonspecific low back pain (NSLBP) should include the targeting of treatment to subgroups of people with identifiable clinical characteristics. However, there are no published systematic reviews of the efficacy of targeted psychosocial interventions. AIM This review aimed to determine if the efficacy of interventions for psychosocial risk factors of persistent NSLBP is improved when targeted to people with particular psychosocial characteristics. METHOD Bibliographic databases were searched. Inclusion criteria were randomised controlled trials of targeted psychosocial interventions that used trial designs capable of providing robust information on the efficacy of targeted treatment (treatment effect modification) for the outcomes of pain, activity limitation and psychosocial factors (fear avoidance, catastrophisation, anxiety and depression). RESULTS AND CONCLUSION Four studies met the inclusion criteria and collectively investigated nine hypotheses about targeted treatment on 28 subgroup/treatment outcomes. There were only two statistically significant results. Graded activity plus Treatment Based Classification targeted to people with high movement-related fear was more effective than Treatment Based Classification at reducing movement-related fear at 4 weeks. Active rehabilitation (physical exercise classes with cognitive-behavioural principles) was more effective than usual GP care at reducing activity limitation at 12 months, when targeted to people with higher movement-related pain. Few studies have investigated targeted psychosocial interventions in NSLBP, using trial designs suitable for measuring treatment effect modification, and they do not provide consistent evidence supporting such targeting. There is a need for appropriately designed and adequately powered trials to investigate targeted psychosocial interventions.
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Pergolizzi J, Ahlbeck K, Aldington D, Alon E, Collett B, Coluzzi F, Huygen F, Jaksch W, Kocot-Kępska M, Mangas AC, Margarit C, Mavrocordatos P, Morlion B, Müller-Schwefe G, Nicolaou A, Pérez Hernández C, Sichere P, Varrassi G. The chronic pain conundrum: should we CHANGE from relying on past history to assessing prognostic factors? Curr Med Res Opin 2012; 28:249-56. [PMID: 22181344 DOI: 10.1185/03007995.2011.651525] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite limited empirical support, chronic pain has traditionally been defined mainly on the basis of its duration, which takes no account of the causative mechanisms or its clinical significance. SCOPE For this commentary on current pain management practice, the CHANGE PAIN Advisory Board considered the evidence for adopting a prognostic definition of chronic pain. The rationale underlying this approach is to take psychological and behavioural factors into account, as well as the multidimensional nature of pain. Measures of pain intensity, interference with everyday activities, role disability, depression, duration and number of pain sites are used to calculate a risk score, which indicates the likelihood of a patient having pain in the future. The consistency of a prognostic definition with the concept of integrated patient care was also considered. FINDINGS When this method was compared with the number of pain days experienced over the previous 6 months--in patients with back pain, headache or orofacial pain--it was a better predictor of clinically significant pain 6 months later for all three pain conditions. Further evidence supporting this approach is that several factors other than the duration of pain have been shown to be important prognostic indicators, including unemployment, functional disability, anxiety and self-rated health. The use of a multifactorial risk score may also suggest specific measures to improve outcomes, such as addressing emotional distress. These measures should be undertaken as part of an integrated pain management strategy; chronic pain is a biopsychosocial phenomenon and all aspects of the patient's pain must be dealt with appropriately and simultaneously for treatment to be effective. CONCLUSION The implementation of a prognostic definition and wider adoption of integrated care could bring significant advantages. However, these measures require improved training in pain management and structural revision of specialist facilities, for which political support is essential.
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Affiliation(s)
- Joseph Pergolizzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Kamper SJ, Maher CG, Menezes Costa LDC, McAuley JH, Hush JM, Sterling M. Does fear of movement mediate the relationship between pain intensity and disability in patients following whiplash injury? A prospective longitudinal study. Pain 2012; 153:113-119. [DOI: 10.1016/j.pain.2011.09.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 09/27/2011] [Accepted: 09/28/2011] [Indexed: 10/15/2022]
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Verkerk K, Luijsterburg PAJ, Ronchetti I, Miedema HS, Pool-Goudzwaard A, van Wingerden JP, Koes BW. Course and prognosis of recovery for chronic non-specific low back pain: design, therapy program and baseline data of a prospective cohort study. BMC Musculoskelet Disord 2011; 12:252. [PMID: 22047019 PMCID: PMC3221649 DOI: 10.1186/1471-2474-12-252] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 11/02/2011] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There has been increasing focus on factors predicting the development of chronic musculoskeletal disorders. For patients already experiencing chronic non-specific low back pain it is also relevant to investigate which prognostic factors predict recovery. We present the design of a cohort study that aims to determine the course and prognostic factors for recovery in patients with chronic non-specific low back pain. METHODS/DESIGN All participating patients were recruited (Jan 2003-Dec 2008) from the same rehabilitation centre and were evaluated by means of (postal) questionnaires and physical examinations at baseline, during the 2-month therapy program, and at 5 and 12 months after start of therapy. The therapy protocol at the rehabilitation centre used a bio-psychosocial approach to stimulate patients to adopt adequate (movement) behaviour aimed at physical and functional recovery. The program is part of regular care and consists of 16 sessions of 3 hours each, over an 8-week period (in total 48 hours), followed by a 3-month self-management program. The primary outcomes are low back pain intensity, disability, quality of life, patient's global perceived effect of recovery, and participation in work. Baseline characteristics include information on socio-demographics, low back pain, employment status, and additional clinical items status such as fatigue, duration of activities, and fear of kinesiophobia. Prognostic variables are determined for recovery at short-term (5 months) and long-term (12 months) follow-up after start of therapy. DISCUSSION In a routine clinical setting it is important to provide patients suffering from chronic non-specific low back pain with adequate information about the prognosis of their complaint.
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Affiliation(s)
- Karin Verkerk
- Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.
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Jørgensen MB, Ektor-Andersen J, Sjøgaard G, Holtermann A, Søgaard K. A randomised controlled trial among cleaners--effects on strength, balance and kinesiophobia. BMC Public Health 2011; 11:776. [PMID: 21985226 PMCID: PMC3201927 DOI: 10.1186/1471-2458-11-776] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 10/10/2011] [Indexed: 11/12/2022] Open
Abstract
Background Cleaners constitute a job group with poor health and low socioeconomic resources. Therefore, there is a great need for scientifically documented health promoting initiatives for cleaners. However, both workplace initiatives and high quality intervention studies are lacking. The aim of this study was to evaluate the effects of a 3-month workplace trial with interventions to improve physical or cognitive behavioural resources among cleaners. Methods A cluster randomised controlled trial was conducted among 294 female cleaners from 9 workplaces. The participants were allocated to three groups: Physical coordination training (PCT, n = 95), Cognitive behavioural theory-based training (CBTr, n = 99) and Reference group (REF, n = 100). Interventions were conducted during work hours for an average of 1 hour/week. Muscle strength was measured by maximal voluntary contractions in trunk/extension, and shoulder abduction/elevation. Postural balance was measured on a force platform. Kinesiophobia was measured with Tampa Scale for Kinesiophobia. Test and questionnaires were completed at baseline and at 3-month follow-up and analyses followed the intention-to-treat (ITT) principle with last observation carried forward in case of missing data at follow-up. Reports and analyses are given on true observations as well. Results ITT-analyses revealed that PCT improved strength of the trunk (p < .05) and postural balance (p < .05) compared to CBTr and REF. Based on true observations the strength and balance improvements corresponded to ~20% and ~16%, respectively. ITT-analyses showed that CBTr reduced kinesiophobia compared to PCT and REF (p < .05). Based on true observations, the improvement corresponded to a ~16% improvement. Conclusion This workplace-based intervention study including PCT and CBTr among cleaners improved strength and postural balance from PCT, and kinesiophobia from CBTr. The improved strength, postural balance and kinesiophobia may improve the cleaners' tolerance for high physical work demands. Future studies should investigate the potential in the combination of PCT and CBTr in a workplace intervention. Trial registration Current controlled trials ISRCTN96241850
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Affiliation(s)
- Marie Birk Jørgensen
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 Copenhagen, Denmark.
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Abstract
Degenerative disk disease is a strong etiologic risk factor of chronic low back pain (LBP). A multidisciplinary approach to treatment is often warranted. Patient education, medication, and cognitive behavioral therapies are essential in the treatment of chronic LBP sufferers. Surgical intervention with a rehabilitation regime is sometimes advocated. Prognostic factors related to the outcome of different treatments include maladaptive pain coping and genetics. The identification of pain genes may assist in determining individuals susceptible to pain and in patient selection for appropriate therapy. Biologic therapies show promise, but clinical trials are needed before advocating their use in humans.
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Structural LSI can occur in the absence of functional LSI. J Orthop Sports Phys Ther 2011; 41:534; author reply 535. [PMID: 21725195 DOI: 10.2519/jospt.2011.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Current world literature. Curr Opin Support Palliat Care 2011; 5:174-83. [PMID: 21521986 DOI: 10.1097/spc.0b013e3283473351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Biopsychosocial factors and perceived disability in saleswomen with concurrent low back pain. Saf Health Work 2010; 1:149-57. [PMID: 22953175 PMCID: PMC3430890 DOI: 10.5491/shaw.2010.1.2.149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 11/04/2010] [Indexed: 11/14/2022] Open
Abstract
Objectives To quantify disability level in salespeople with concurrent low back pain (LBP) and to determine the relative associations between demographic, occupational, psychosocial and clinical factors and back disability. LBP is the most common cause of work-related disability in people under 45 years of age and the most expensive cause of work-related disability, in terms of workers' compensation and medical expenses. Evidence suggests high prevalence of LBP in salespeople. Methods A cross-sectional survey was conducted in which 184 saleswomen with a current episode of self-reported LBP working in a large up-scale department store filled out a battery of 6 self-administered questionnaires and received a standardised physical examination. Results Saleswomen with concurrent LBP had low disability levels. Factors significantly associated with disability were pain intensity, measured by a visual analogue scale, in the past week (p < 0.001), physical and mental health status (p < 0.001, p = 0.003, respectively), fear avoidance scores for both work and physical activities (p = 0.031, p = 0.014, respectively), past history of LBP (p = 0.019), and self-reported frequency of pushing or pulling objects placed in high positions during work (p = 0.047). A significant level (45%) of the variance in disability status was explained by these variables. Conclusion In clinical management of LBP workers who required prolonged standing, such as salespeople, clinicians should look for modifiable risk factors associated with disability. Specific measures need to be taken to prevent disability due to LBP among salespeople.
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