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Ahn SE, Lee MY, Lee BH. Effects of Gluteal Muscle Strengthening Exercise-Based Core Stabilization Training on Pain and Quality of Life in Patients with Chronic Low Back Pain. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:849. [PMID: 38929466 PMCID: PMC11205821 DOI: 10.3390/medicina60060849] [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: 04/02/2024] [Revised: 05/02/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
Background: The World Health Organization reports that back pain is a major cause of disorder worldwide. It is the most common musculoskeletal disorder with limited pain, muscle tension, and stiffness, and 70-80% of all individuals experience it once in their lifetime, with higher prevalence in women than in men. This study aimed to investigate the effects of gluteal muscle strengthening exercise- based core stabilization training (GSE-based CST) on pain, function, fear-avoidance patterns, and quality of life in patients with chronic back pain. Methods: This study included 34 patients with non-specific chronic low back pain. Seventeen individuals each were included in GSE-based CST and control groups. The GSE-based CST group performed GSE and CST for 15 min, three times a week for four weeks, and the control group performed CST for 30 min a day, three times a week for four weeks. The numeric pain rating scale was used to evaluate pain before and after treatment, Roland-Morris disability questionnaire was used to evaluate function, fear-avoidance beliefs questionnaire was used to evaluate fear-avoidance patterns, and quality of life was measured using the short form-36. Results: In this study, pain, function, and fear-avoidance pattern decreased significantly in both groups (All p < 0.05). During the evaluation of quality of life, both groups showed significant increase in physical and mental factors (p < 0.05). There were significant differences in pain and quality of life (p < 0.05) between the GSE-based CST and control groups. Conclusions: Therefore, GSE-based CST can be used as a basis for effective intervention to enhance pain, function, fear-avoidance patterns, and quality of life, emphasizing the need for gluteal muscle strengthening exercises in patients with non-specific chronic back pain in the future.
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Affiliation(s)
- Seung-Eon Ahn
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea;
| | - Mi-Young Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea;
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea;
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Gabel CP, Cuesta-Vargas A, Dibai-Filho AV, Mokhtarinia HR, Melloh M, Bejer A. Developing a shortened spine functional index (SFI-10) for patients with sub-acute/chronic spinal disorders: a cross-sectional study. BMC Musculoskelet Disord 2024; 25:236. [PMID: 38532353 PMCID: PMC10964542 DOI: 10.1186/s12891-024-07352-x] [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: 12/04/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Brief whole-spine patient-reported outcome measures (PROMs) provide regional solutions and future directions for quantifying functional status, evidence, and effective interventions. The whole-spine regional Spine Functional Index (SFI-25) is used internationally in clinical and scientific contexts to assess general sub-acute/chronic spine populations. However, to improve structural validity and practicality a shortened version is recommended. This study developed a shortened-SFI from the determined optimal number of item questions that: correlated with criteria PROMs being highly with whole-spine, moderately with regional-spine, condition-specific and patient-specific, and moderately-low with general-health and pain; retained one-dimensional structural validity and high internal consistency; and improved practicality to reduce administrative burden. METHODS A cross-sectional study (n = 505, age = 18-87 yrs., average = 40.3 ± 10.1 yrs) of sub-acute/chronic spine physiotherapy outpatients from an international sample of convenience. Three shortened versions of the original SFI-25 were developed using 1) qualitative 'content-retention' methodology, 2) quantitative 'factorial' methodology, and 3) quantitative 'Rasch' methodology, with a fourth 'random' version produced as a comparative control. The clinimetric properties were established for structural validity with exploratory (EFA) and confirmatory (CFA) factorial analysis, and Rasch analysis. Criterion validity used the: whole-spine SFI-25 and Functional Rating Index (FRI); regional-spine Neck Disability Index (NDI), Oswestry Disability Index (ODI), and Roland Morris Questionnaire (RMQ), condition-specific Whiplash Disability Questionnaire (WDQ); and patient-specific functional scale (PSFS); and determined floor/ceiling effect. A post-hoc pooled international sub-acute/chronic spine sample (n = 1433, age = 18-91 yrs., average = 42.0 ± 15.7 yrs) clarified the findings and employed the general-health EuroQuol-Index (EQ-5D), and 11-point Pain Numerical Rating Scale (P-NRS) criteria. RESULTS A 10-item SFI retained structural validity with optimal practicality requiring no computational aid. The SFI-10 concept-retention-version demonstrated preferred criterion validity with whole-spine criteria (SFI-25 = 0.967, FRI = 0.810) and exceeded cut-off minimums with regional-spine, condition-specific, and patient-specific measures. An unequivocal one-dimensional structure was determined. Internal consistency was satisfactory (α = 0.80) with no floor/ceiling effect. Post-hoc analysis of the international sample confirmed these findings. CONCLUSION The SFI-10 qualitative concept-retention version was preferred to quantitative factorial and Rasch versions, demonstrated structural and criterion validity, and preferred correlation with criteria measures. Further longitudinal research is required for reliability, error, and responsiveness, plus an examination of the practical characteristics of readability and administrative burden.
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Affiliation(s)
| | - Antonio Cuesta-Vargas
- Department of Psychiatry and Physiotherapy, Faculty of Medicine, Malaga University, Malaga, Spain
| | | | - Hamid Reza Mokhtarinia
- Department of Ergonomics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Markus Melloh
- Queensland University of Technology, School of Public Health and Social Work, Brisbane, Australia
| | - Agnieszka Bejer
- Institute of Health Sciences, Medical College, Rzeszow University, Rzeszow, Poland
- The Holy Family Specialist Hospital, Rudna Mała 600, 36-060, Głogów Małopolski, Poland
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de Oliveira Grigorini AE, Pereira LSM, Koes B, da Silva SLA, Chiarotto A, Felício DC, Leopoldino AAO. Does the intensity of pain and disability affect health-related quality of life of older adults with back pain? Multilevel analysis between Brazil and Netherlands: a cross-sectional study of the BACE consortium. BMC Geriatr 2024; 24:230. [PMID: 38443807 PMCID: PMC10916242 DOI: 10.1186/s12877-024-04803-x] [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] [Received: 07/31/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The prognosis of back pain (BP) in the older adults is less favorable than in younger adults and progress to adverse outcomes and consequent worsening of health-related quality of life (HRQoL). The present study aimed to verify the association between BP intensity, disability and HRQoL in older adults residents in Brazil and Netherlands, and to evaluate whether the country of residence influences the associations. METHODS Data were collected from 602 Brazilian and 675 Dutch participants with a new episode of BP from the Back Complaints in Elders (BACE) consortium. For the present study, a cross section was used. Pain intensity and disability were assessed using the Numerical Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. HRQoL was assessed using the Short Form Health Survey (SF-36) quality of life questionnaire. Age, sex, and education were descriptive variables. Pain intensity (NPS score) and country were the independent variables and quality of life assessed by each SF domain - 36 was the dependent variable. Analysis of models at the individual level was performed to verify the association between pain and disability, also HRQoL in Netherlands and Brazil in the total sample. The multilevel model was used to verify whether the older adults person's country of residence influenced this relationship. RESULTS The average age of the participants was 67.00 (7.33) years. In the total sample, linear regression analysis adjusted for sex and age showed a significant association between BP intensity scores and HRQoL, for all domains. There was no association between disability and HRQoL. In the multilevel analysis, there was an association between BP intensity and HRQoL in all domains and an association between the country of residence and HRQoL, influencing the effect of pain, in all domains, except for the physical functioning. CONCLUSION Socioeconomic and cultural aspects of different countries can affect the perception of the elderly about their HRQoL in the presence of BP. Pain and disability in Brazilian and Dutch older adults ones are experienced differently in relation to their HRQoL.
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Affiliation(s)
- Adriana Estela de Oliveira Grigorini
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, 275 Alameda Ezequiel Dias, 30130-110, Belo Horizonte, Minas Gerais, Brazil
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, 275 Alameda Ezequiel Dias, 30130-110, Belo Horizonte, Minas Gerais, Brazil
- Department of Physical Therapy, Graduate Program in Rehabilitation Science, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bart Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Diogo Carvalho Felício
- Department of Physical Therapy, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Amanda Aparecida Oliveira Leopoldino
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, 275 Alameda Ezequiel Dias, 30130-110, Belo Horizonte, Minas Gerais, Brazil.
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Robinson CL, Phung A, Dominguez M, Remotti E, Ricciardelli R, Momah DU, Wahab S, Kim RS, Norman M, Zhang E, Hasoon J, Orhurh V, Viswanath O, Yazdi C, Chen GH, Simopoulos TT, Gill J. Pain Scales: What Are They and What Do They Mean. Curr Pain Headache Rep 2024; 28:11-25. [PMID: 38060102 DOI: 10.1007/s11916-023-01195-2] [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] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW It is essential to have validated and reliable pain measurement tools that cover a wide range of areas and are tailored to individual patients to ensure effective pain management. The main objective of this review is to provide comprehensive information on commonly used pain scales and questionnaires, including their usefulness, intended purpose, applicability to different patient populations, and associated advantages and disadvantages. RECENT FINDINGS Acute pain questionnaires typically focus on measuring the severity of pain and the extent of relief achieved through interventions. Chronic pain questionnaires evaluate additional aspects such as pain-related functional limitations, psychological distress, and psychological well-being. The selection of an appropriate pain scale depends on the specific assessment objectives. Additionally, each pain scale has its strengths and limitations. Understanding the differences among these pain scales is essential for selecting the most appropriate tool tailored to individual patient needs in different settings. CONCLUSION Medical professionals encounter challenges in accurately assessing pain. Physicians must be familiar with the different pain scales and their applicability to specific patient population.
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Affiliation(s)
- Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anh Phung
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Moises Dominguez
- Department of Neurology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Edgar Remotti
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ryan Ricciardelli
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - D Uju Momah
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephanie Wahab
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rosa S Kim
- Department of General Surgery, Georgetown University Hospital, MedStar, Washington, DC, USA
| | | | - Evan Zhang
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, USA.
| | - Vwaire Orhurh
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
- MVM Health, East Stroudsburg, PA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Grant H Chen
- Department of Anesthesiology, Critical Care and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, USA
| | - Thomas T Simopoulos
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jatinder Gill
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Rhon DI, Greenlee TA, Poehlein E, Beneciuk JM, Green CL, Hando BR, Childs JD, George SZ. Effect of Risk-Stratified Care on Disability Among Adults With Low Back Pain Treated in the Military Health System: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2321929. [PMID: 37410465 PMCID: PMC10326636 DOI: 10.1001/jamanetworkopen.2023.21929] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/19/2023] [Indexed: 07/07/2023] Open
Abstract
Importance Tailored treatments for low back pain (LBP) based on stratifying risk for poor prognosis have emerged as a promising approach to improve quality of care, but they have not been validated in trials at the level of individual randomization in US health systems. Objective To assess the clinical effectiveness of risk-stratified vs usual care on disability at 1 year among patients with LBP. Design, Setting, and Participants This parallel-group randomized clinical trial enrolled adults (ages 18-50 years) seeking care for LBP with any duration in primary care clinics within the Military Health System from April 2017 to February 2020. Data analysis was conducted from January to December 2022. Interventions Risk-stratified care, in which participants received physiotherapy treatment tailored for their risk category (low, medium, or high), or usual care, in which care was determined by participants' general practitioners and may have included a referral to physiotherapy. Main Outcomes and Measures The primary outcome was the Roland Morris Disability Questionnaire (RMDQ) score at 1 year, with planned secondary outcomes of Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Physical Function (PF) scores. Raw downstream health care utilization was also reported within each group. Results Analysis included 270 participants (99 [34.1%] female participants; mean [SD] age, 34.1 [8.5] years). Only 21 patients (7.2%) were classified as high risk. Neither group was superior on the RMDQ (least squares [LS] mean ratio of risk-stratified vs usual care: 1.00; 95% CI, 0.80 to 1.26), the PROMIS PI (LS mean difference, -0.75 points; 95% CI -2.61 to 1.11 points), or the PROMIS PF (LS mean difference, 0.05 points; 95% CI, -1.66 to 1.76 points). Conclusions and Relevance In this randomized clinical trial, using risk stratification to categorize and provide tailored treatment for patients with LBP did not result in better outcomes at 1 year compared with usual care. Trial Registration ClinicalTrials.gov Identifier: NCT03127826.
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Affiliation(s)
- Daniel I. Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, Maryland
| | - Tina A. Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
| | - Emily Poehlein
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Jason M. Beneciuk
- Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, Gainesville
- Brooks Rehabilitation Clinical Research Center, Jacksonville, Florida
| | - Cynthia L. Green
- Department of Biostatistics and Bioinformatics and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Ben R. Hando
- Department of Orthopaedics and Rehabilitation, Wilford Hall Ambulatory Surgical Center, JBSA Lackland, Texas
| | | | - Steven Z. George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, School of Medicine, Durham, North Carolina
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Huo M, Ho E, Kongsted A, Patterson T, Ferreira P. Association between physical activity, sedentary behaviour and the trajectory of low back pain. Spine J 2023; 23:1037-1044. [PMID: 36948275 DOI: 10.1016/j.spinee.2023.03.006] [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: 12/23/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Low back pain (LBP) is one of the world's most prevalent health issues. Patients with LBP experience various intensities and durations of symptoms, which can lead to distinctive course patterns commonly described as symptom trajectories. PURPOSE This study aimed to investigate the association between different amounts of physical activity and sedentary behavior and the trajectory of LBP, in people with a lifetime history of LBP. STUDY DESIGN The study involved a secondary analysis of observational longitudinal data collected from the AUstralian Twin low BACK pain (AUTBACK) study. METHODS A total of 329 individual twins met the inclusion criteria for analysis. Latent Class Growth Analysis was used to identify distinct patterns of LBP and select the primary outcome (probability of having a severe LBP trajectory, 0%-100%). Linear regression models were used to investigate the association between different amounts of physical activity or sedentary behavior at baseline, and the probability of having a severe LBP trajectory. Results were expressed as β coefficients and 95% confidence intervals (CI). RESULTS Moderate-to-vigorous intensity physical activity was significantly associated with the probability of having a severe LBP trajectory (unadjusted β -0.0276; 95%CI -0.0456 to -0.0097, p=.003). For every 1-minute increase in moderate-to-vigorous intensity physical activity per week, there was a 2.8%-point reduction in a participant's probability of having a severe LBP trajectory. No significant associations were identified between sedentary behavior or light intensity physical activity, and the probability of having a severe LBP trajectory. CONCLUSIONS In people with a lifetime history of LBP, engagement in higher volumes of moderate to vigorous intensity physical activity at baseline was associated with a lower probability of developing a severe trajectory of LBP over 1 year.
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Affiliation(s)
- Meiyi Huo
- Sydney Musculoskeletal Health, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Susan Wakil Health Building, Western Ave, Camperdown, NSW, 2050, Australia.
| | - Emma Ho
- Sydney Musculoskeletal Health, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Susan Wakil Health Building, Western Ave, Camperdown, NSW, 2050, Australia; Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Western Ave, Camperdown, NSW, 2050, Australia
| | - Alice Kongsted
- Department of Sports Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark
| | - Thomas Patterson
- Sydney Musculoskeletal Health, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Susan Wakil Health Building, Western Ave, Camperdown, NSW, 2050, Australia
| | - Paulo Ferreira
- Sydney Musculoskeletal Health, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Susan Wakil Health Building, Western Ave, Camperdown, NSW, 2050, Australia
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Pontes-Silva A. Letter to the editor regarding "A novel physical functioning test to complement subjective questionnaires in chronic low back pain assessments" by Sutanto et al. Spine J 2023; 23:1096-1097. [PMID: 37349005 DOI: 10.1016/j.spinee.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/15/2023] [Indexed: 06/24/2023]
Affiliation(s)
- André Pontes-Silva
- Physical Therapy Post-Graduate Program (PPGFT), Physical Therapy Department (DFisio), Federal University of São Carlos (UFSCar), Rod. Washington Luis, Km 235, CEP 13565-905, São Carlos, SP, Brazil.
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Ogunniran IA, Akodu AK, Odebiyi DO. Effects of kinesiology taping and core stability exercise on clinical variables in patients with non-specific chronic low back pain: A randomized controlled trial. J Bodyw Mov Ther 2023; 33:20-27. [PMID: 36775519 DOI: 10.1016/j.jbmt.2022.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 04/26/2022] [Accepted: 09/18/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Properly-designed exercises and use of different physiotherapeutic modalities have been shown to be useful in the management of patients with non-specific chronic low back pain (NSCLBP). This research examined the effects of Kinesiology taping (KT) and Core-stabilization exercises (CSE) on pain intensity, lumbar range of motion, functional disability, depression, anxiety, sleep disturbance and Kinesiophobia in patients with NSCLBP. DESIGN Randomized controlled trial. SETTINGS Two tertiary health facilities. PARTICIPANTS Thirty-five patients (28 males and 7 females) with NSCLBP were allocated into three groups (KT + CSE, CSE and KT only). MAIN OUTCOME MEASURE Pain intensity, functional disability, psychological status, sleep disturbance, kinesiophobia and lumbar range of motion (LROM) were assessed. RESULTS The results revealed reduction in pain intensity, improved functional ability, psychological status (Depression and Anxiety), kinesiophobia, decreased sleep disturbance and increased LROM (P < 0.001) within each of the groups post-intervention. CONCLUSION All participants had improved clinical outcomes. However, KT + CSE group had better result in all the clinical outcomes. CLINICAL TRIAL REGISTRY NUMBER PACTR201807604459572.
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Affiliation(s)
- I A Ogunniran
- Department of Physiotherapy, College of Medicine, University of Lagos, Nigeria
| | - A K Akodu
- Department of Physiotherapy, College of Medicine, University of Lagos, Nigeria.
| | - D O Odebiyi
- Department of Physiotherapy, College of Medicine, University of Lagos, Nigeria
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Smart KM, Hinwood NS, Dunlevy C, Doody CM, Blake C, Fullen BM, Le Roux CW, O'Connell J, Gilsenan C, Finucane FM, O'Donoghue G. Multidimensional pain profiling in people living with obesity and attending weight management services: a protocol for a longitudinal cohort study. BMJ Open 2022; 12:e065188. [PMID: 36526309 PMCID: PMC9764675 DOI: 10.1136/bmjopen-2022-065188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Pain is prevalent in people living with overweight and obesity. Obesity is associated with increased self-reported pain intensity and pain-related disability, reductions in physical functioning and poorer psychological well-being. People living with obesity tend to respond less well to pain treatments or management compared with people living without obesity. Mechanisms linking obesity and pain are complex and may include contributions from and interactions between physiological, behavioural, psychological, sociocultural, biomechanical and genetic factors. Our aim is to study the multidimensional pain profiles of people living with obesity, over time, in an attempt to better understand the relationship between obesity and pain. METHODS AND ANALYSIS This longitudinal observational cohort study will recruit (n=216) people living with obesity and who are newly attending three weight management services in Ireland. Participants will complete questionnaires that assess their multidimensional biopsychosocial pain experience at baseline and at 3, 6, 12 and 18 months post-recruitment. Quantitative analyses will characterise the multidimensional pain experiences and trajectories of the cohort as a whole and in defined subgroups. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics and Medical Research Committee of St Vincent's Healthcare Group, Dublin, Ireland (reference no: RS21-059) and the University College Dublin Human Research Ethics Committee (reference no: LS-E-22-41-Hinwood-Smart). Findings will be disseminated through peer-reviewed journals, conference presentations, public and patient advocacy groups, and social media. STUDY REGISTRATION Open Science Framework Registration DOI: https://doi.org/10.17605/OSF.IO/QCWUE.
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Affiliation(s)
- Keith M Smart
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Physiotherapy Department, St Vincent's University Hospital, Dublin, Ireland
- UCD Centre for Translational Pain Research, University College Dublin, Dublin, Ireland
| | - Natasha S Hinwood
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Colin Dunlevy
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
| | - Catherine M Doody
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- UCD Centre for Translational Pain Research, University College Dublin, Dublin, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- UCD Centre for Translational Pain Research, University College Dublin, Dublin, Ireland
| | - Brona M Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- UCD Centre for Translational Pain Research, University College Dublin, Dublin, Ireland
| | - Carel W Le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Jean O'Connell
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
| | - Clare Gilsenan
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Francis M Finucane
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
- School of Medicine, College of Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Grainne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Abdullahi A, Aliyu K, Hassan AB, Sokunbi GO, Bello B, Saeys W, Truijen S. Prevalence of chronic non-specific low back pain among caregivers of stroke survivors in Kano, Nigeria and factors associated with it: A cross-sectional study. Front Neurol 2022; 13:900308. [PMID: 36277934 PMCID: PMC9581006 DOI: 10.3389/fneur.2022.900308] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/30/2022] [Indexed: 02/03/2023] Open
Abstract
Purpose Low back pain (LBP) may have a specific or non-specific cause such as abnormal posture or repetitive tasks. For instance, lifting and transferring patients during caregiving for stroke survivors may predispose the caregivers to LBP. Objectives The aim of this study is to determine the prevalence of chronic non-specific LBP and factors associated with it in caregivers of stroke survivors. Method The research design used is cross-sectional study design. Participants of the study were caregivers of stroke survivors in Kano, Nigeria who were at least 18 years old. They were included if they had at least one-month experience with caregiving for at least 1 h per day. Presence of LBP and level of disability were assessed using participants' self-report and Rolland Morris Low Back Pain Disability Questionnaire respectively. The data collected was analyzed using descriptive, Chi-square statistics and Binary Logistics Regression. Result Three hundred caregivers with mean age, 33.24 ± 10.32 years in which 207 and 93 were males and females respectively, participated in the study. The results showed that, there was a high prevalence (64.7%) of LBP among the caregivers. The prevalence was significantly associated with gender (p < 0.001), age (p = 0.029), occupation (p < 0.001) and duration of caregiving (p < 0.001) of the study participants. In addition, the result of the regression model showed that, being a female (p = 0.001), a civil servant (p = 0.031), a trader (p = 0.013), and a complete caregiver (0.001); and caregiving for a duration of 5 h or more per day (p = 0.024) are significant predictors of having LBP. Similarly, level of disability due to the presence of LBP among the study participants was significantly associated with gender (p < 0.001), occupation (p < 0.001), duration of caregiving (p = 0.025), and the nature of the caregiving (p < 0.001). Conclusion Informal caregiving for stroke survivors may result in developing chronic non-specific LBP, especially among females, Civil servants, traders, complete caregivers and those with long duration of caregiving. This can add an additional burden on the family in terms of cost of care, result in reduced quality of caregiving and cause psychological stress. Thus, it is important the health of the caregivers of stroke survivors is considered during stroke rehabilitation.
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Affiliation(s)
- Auwal Abdullahi
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
- *Correspondence: Auwal Abdullahi
| | - Kamilu Aliyu
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
| | - Auwal Bello Hassan
- Department of Medical Rehabilitation (Physiotherapy), College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | | | - Bashir Bello
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
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Takara KS, Alamino Pereira de Viveiro L, Moura PA, Marques Pasqual A, Pompeu JE. Roland-Morris disability questionnaire is bidimensional and has 16 items when applied to community-dwelling older adults with low back pain. Disabil Rehabil 2022:1-7. [PMID: 35798682 DOI: 10.1080/09638288.2022.2096127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To explore the evidence of the internal structure validity of the Roland-Morris Disability Questionnaire in older adults with low back pain. METHODS This was a cross-sectional study of psychometric testing involving 528 older adults with low back pain. Internal structure validity was explored by exploratory factor analysis and semi-confirmatory factor analysis. Reliability was verified using Kuder-Richardson Formula 20, Cronbach's alpha, and McDonald's omega. Replicability was observed by the generalized H index. RESULTS Roland-Morris Disability Questionnaire displayed two factors that assess "functional capacity" and "mobility". Eight items were excluded for presenting cross-loading (2 and 10), inadequate loading factors and communalities (18, 24, 13, and 12), or did not relate to the latent construct (15 and 22). Semi-confirmatory factor analysis indicated that the questionnaire had a good fitness model [X2 = 153.698 (p = 0.00001); RMSEA = 0.037; RMSR = 0.06; WRMR = 0.04; NNFI = 0.987; GFI = 0.979; AGFI = 0.971]. Reliability was acceptable (KR-20 = 0.79; Cronbach's alpha = 0.86; McDonald's Omega = 0.85), but replicability was poor in both factors (G-H factor 1 = 0.816-0.655; G-H factor 2 = 0.889-0.775). CONCLUSIONS The most appropriate version of the Roland-Morris Disability Questionnaire to apply to older adults with low back pain has 16 items and assesses functional capacity and mobility. IMPLICATIONS FOR REHABILITATIONThe RMDQ-16 is the most appropriate version of the RMDQ to use in older adults with LBP;The RMDQ-16 is bidimensional and assesses "functional capacity" and "mobility";The poor replicability of the RMDQ-16 indicates that it will probably not be stable across studies, but it can be useful in a clinical setting.
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Affiliation(s)
- Kelly Sayuri Takara
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Larissa Alamino Pereira de Viveiro
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Patricia Albuquerque Moura
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Amélia Marques Pasqual
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - José Eduardo Pompeu
- Department of Physical Therapy, Speech Therapy, and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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Patterson T, Beckenkamp P, Ferreira M, Bauman A, Carvalho-E-Silva AP, Ferreira LC, Ferreira P. The impact of different intensities and domains of physical activity on analgesic use and activity limitation in people with low back pain: a prospective cohort study with a one-year follow-up. Eur J Pain 2022; 26:1636-1649. [PMID: 35642334 PMCID: PMC9544541 DOI: 10.1002/ejp.1987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Analgesics are the most common form of managing low back pain (LBP). No previous study has examined which domains and intensities of physical activity are most beneficial in reducing the frequency of analgesic use for LBP, and its related activity limitation. METHODS This cohort study forms part of the AUstralian Twin low BACK pain study, investigating the impact of physical activity on LBP. Information on demographics, LBP and health-related factors, including physical activity were collected at baseline. Data on the total counts of analgesic use and activity limitation for LBP were collected weekly for one-year. Negative binomial regression models were conducted separately for each type of physical activity. Results were presented as Incidence Rate Ratios (IRR) and 95% Confidence Intervals (CI). RESULTS From an initial sample of 366 participants, 86 participants reported counts of analgesic use and 140 recorded counts of activity limitation across the follow up period. The negative binomial regression models for analgesic use counts indicated moderate-vigorous physical activity (IRR 0·97, 95% C.I 0·96-0·99) and physical workload (IRR 1·02, 95% C.I 1·01-1·05) to be significant. For activity limitation counts, significant associations were shown for sedentary time (IRR 1·04, 95% C.I 1·01-1·09) and leisure activity (IRR 0·94, 95% C.I 0·81-0·99). CONCLUSIONS Our findings highlight the potential importance of supporting engagement in moderate-vigorous and leisure physical activity, as well as minimising sedentary time and physical workload to reduce the risk of activity limitation and the need for analgesic use in people with LBP.
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Affiliation(s)
- Thomas Patterson
- The University of Sydney, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Susan Walking Building D18 Western Avenue, Camperdown, NSW, Australia
| | - Paula Beckenkamp
- The University of Sydney, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Susan Walking Building D18 Western Avenue, Camperdown, NSW, Australia
| | - Manuela Ferreira
- The University of Sydney, Sydney Musculoskeletal Health, School of Health Sciences, The Kolling Institute of Medical Research, Faculty of Medicine and Health, Kolling Building, St Leonards, NSW, Australia
| | - Adrian Bauman
- The University of Sydney, Public Health, Sydney School of Public Health, Faculty of Medicine and Health, Edward Ford Building A27 Fisher Rd, Camperdown, NSW, Australia
| | - Ana Paula Carvalho-E-Silva
- The University of Sydney, Public Health, Sydney School of Public Health, Faculty of Medicine and Health, Edward Ford Building A27 Fisher Rd, Camperdown, NSW, Australia
| | - Lucas Calais Ferreira
- The University of Melbourne, Twins Research Australia Unit, School of Population and Global Health, 207 Bouverie St, Carlton, VIC, Australia
| | - Paulo Ferreira
- The University of Sydney, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Susan Walking Building D18 Western Avenue, Camperdown, NSW, Australia
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The impact of endoscopic activity on musculoskeletal disorders of high-volume endoscopists in Germany. Sci Rep 2022; 12:8538. [PMID: 35595856 PMCID: PMC9123012 DOI: 10.1038/s41598-022-12400-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/03/2022] [Indexed: 12/03/2022] Open
Abstract
Physical stress is common in GI endoscopists, leading to musculoskeletal disorders. Considering the increasing complexity of interventional GI endoscopy with prolonged examination time, work-related musculoskeletal disorders have come into focus. However, data on work-related health stress in German endoscopists are elusive. The aim of this study was therefore to investigate the prevalence and consequences of work-related musculoskeletal disorders in German endoscopists. A 24-item questionnaire on endoscopy-associated musculoskeletal disorders and standardized pain assessment was developed by an interdisciplinary team of endoscopists and sports medics. The survey was distributed online by the leading German societies for gastroenterology and endoscopy. Overall, 151 German practicing endoscopists took part in the study. Regarding the average number of endoscopic procedures per week, the study collective consisted mainly of high-volume endoscopists. The survey showed that most participants suffered from general musculoskeletal disorders (82.8%) and from work-related musculoskeletal disorders (76.8%). The most affected body parts were the neck, low back, thumb, and shoulder. Temporary absence from work due to symptoms was reported by 9.9% of the respondents. Over 30% of participating endoscopists stated the need for analgesics or physiotherapy due to musculoskeletal disorders. Age, professional experience and work time were identified as relevant risk factors for musculoskeletal health issues. A high number of German endoscopists are affected by musculoskeletal disorders due to specific working postures and repetitive movements with a large impact on personal health. Further interventional studies are mandatory to improve the risk prevention of endoscopic activity.
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Impact of Work-Related Chronic Low Back Pain on Functional Performance and Physical Capabilities in Women and Men: A Sex-Wise Comparative Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6307349. [PMID: 35281614 PMCID: PMC8913110 DOI: 10.1155/2022/6307349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/16/2022] [Indexed: 01/07/2023]
Abstract
Purpose This study is aimed at determining the impact of work-related low back pain (LBP) on functional performance and physical capabilities. Methods This cross-sectional study included women (n = 25, mean age, 38.12 ± 4.59) and men (n = 25, mean age, 37.20 ± 5.38) with a history of work-related mechanical chronic LBP who visited our university hospital's outpatient department. All participants were assessed for primary outcomes, including the severity of LBP on rest and on activity, functional performance, and physical capabilities using a numeric pain rating scale (NPRS), Roland-Morris disability questionnaire (RDQ), five-time sit-to-stand test (FTSST), and fifty-foot walk test (FFWT), respectively. Independent t-tests compared the scores of the outcomes between groups while Pearson's correlation coefficient identified the correlation between the outcomes' measures at a significance level of 0.05. Results With a response rate of 63.29%, a total of fifty participant's data were obtained for the analysis. A comparison between women and men groups highlighted a significant difference in the scores of the FTSST and FFWT; however, there were insignificant differences in the scores of the NPRS at rest, NPRS on activity, and RDQ. The bivariate correlation revealed a highly significant, positive, and moderate correlation between the scores of NPRS at rest and FTSST, NPRS on activity and FTSST, NPRS at rest and FFWT, NPRS on activity and FFWT, FTSST and RDQ, and FFWT and RDQ in the women group. Similarly, there was a significant, positive, and low correlation between the scores of FTSST and RDQ and FFWT and RDQ in the men group. Conclusion Work-related chronic LBP affected the physical capabilities of women more than those of men. However, it equally affected the functional performance of all participants in the study. Furthermore, work-related chronic LBP affected the physical capabilities (FTSST and FFWT) and functional performance (RDQ) of women more than those of men.
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Factors associated with care-seeking for low back pain when genetics and the familial environment are considered. Musculoskelet Sci Pract 2021; 53:102365. [PMID: 33765632 DOI: 10.1016/j.msksp.2021.102365] [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] [Received: 10/30/2020] [Revised: 02/12/2021] [Accepted: 03/05/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low back pain (LBP) is the leading cause of disability worldwide. Care-seekers for LBP cause substantial economic burden to governments and the healthcare system. OBJECTIVE To investigate lifestyle and health-related factors associated with care-seeking (including pain medication use) in individuals experiencing LBP, after controlling for important genetic and early environmental confounders through the use of a within-twin pair case-control design. DESIGN A secondary analysis of observational longitudinal data, derived from the Australian Twin low BACK pain (AUTBACK) study, was performed on 66 twin pairs that presented with similar symptoms of LBP at baseline but became discordant for care-seeking behaviour over one month. METHODS Subjective and objective assessment of pain intensity, disability, depression, sleep quality, physical activity and body mass index were performed. Data was analysed using stepwise conditional logistic regression in two stages: within-pair case-control for monozygotic and dizygotic twins together; and within-pair case-control analysis of monozygotic twins only. Results were expressed as odds ratios (OR) and 95% confidence intervals (CI). RESULTS Higher LBP intensity (OR 2.9; 95% CI 1.3-6.8) and poorer sleep quality (OR 10.9; 95% CI 1.5-77.7) were the main factors that increased the likelihood of care-seeking for LBP. These associations remained significant and increased in magnitude after adjusting for genetic confounding. CONCLUSIONS Individuals with higher LBP intensity and worse sleep quality are more likely to seek care for LBP, and this relationship is likely to be causal after adjustment of familial and genetic confounding.
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Alhowimel A, Alotiabi M, Coulson N, Radford K. Feasibility study and process evaluation of MRI plus physiotherapy vs. physiotherapy alone in non-specific chronic low back pain among patients in Saudi Arabia. Pilot Feasibility Stud 2020; 6:188. [PMID: 33292710 PMCID: PMC7702682 DOI: 10.1186/s40814-020-00731-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/18/2020] [Indexed: 11/12/2022] Open
Abstract
Aim To determine the feasibility of conducting a definitive randomised control trial (RCT) to answer the following questions: (1) Is early physiotherapy treatment acceptable and feasible for patients and direct healthcare providers? and (2) Is early physiotherapy intervention associated with better disability and psychosocial outcomes compared with the practice of routine MRIs? Methods In a feasibility RCT in Riyadh City from 01 March 2018 until 29 July 2018, chronic low back pain (CLBP) patients presenting to spine clinics were randomised to receive an MRI (intervention) plus physiotherapy rehabilitation or physiotherapy alone (control group). The acceptability of randomisation to the control group (non-MRI) was tested during the recruitment by qualitatively interviewing study participants and referring physicians. Moreover, interviews with study participants explored the broader social, political, economic, and environmental (context) aspects that may influence trial delivery and intervention implementation. Results The recruitment target was not met: 16/24 (66%) participants were recruited in 4 months (12.4% of those screened); 33% declined. The process evaluation identified numerous factors that may affect the success of a definitive RCT in Saudi Arabia. These were research resources, the lack of research infrastructure to support recruitment to trials, limited research capacity in terms of knowledge and skills of the healthcare team, and limited funding. Conclusion A definitive RCT to test the influence of MRI diagnosis on the psychosocial and disability outcomes in people with CLBP treated with physiotherapy in Saudi Arabia is feasible. However, the lack of research infrastructure, research capacity, the impact of MRI on patient outcomes, and a lack of clinical equipoise in the treatment and management of CLBP in Saudi Arabia pose major barriers to clinical trials.
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Affiliation(s)
- Ahmed Alhowimel
- Physical Therapy and Rehabilitation Science Department, Prince Sattam Bin AbdulAziz University, Alkarj, Saudi Arabia.
| | - Mazyad Alotiabi
- Physical Therapy and Rehabilitation Science Department, Prince Sattam Bin AbdulAziz University, Alkarj, Saudi Arabia
| | - Neil Coulson
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kathryn Radford
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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de Jesus-Moraleida FR, Ferreira PH, Silva JP, Andrade AGP, Dias RC, Dias JMD, Assis MG, Pereira LSM. Relationship Between Physical Activity, Depressive Symptoms and Low Back Pain Related Disability in Older Adults With Low Back Pain: A Cross-Sectional Mediation Analysis. J Aging Phys Act 2020; 28:686-691. [PMID: 32335532 DOI: 10.1123/japa.2019-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 11/18/2022]
Abstract
Low back pain (LBP) can be less disabling in those who are physically active. This study analyzed the association between physical activity (PA)- and LBP-related disability in older people with LBP, exploring if this association was mediated by depressive symptoms. The authors analyzed the relationship between PA levels and disability using the short version of the International Physical Activity Questionnaire and the Roland-Morris Disability Questionnaire, respectively, collected at baseline from the Brazilian Back Complaints in the Elders study. The authors investigated depressive symptoms as a mediator of this association using the Center of Epidemiologic Studies Depression scale. PA was inversely associated with disability. This association was smaller when considering the indirect effect through depressive symptoms. Thus, depressive symptoms partially mediated the association between PA and disability in older adults with LBP, and higher levels of PA were associated with less depressive symptoms and disability.
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Bhandari M, Mathur W, Kosta S, Salvi P, Fobi M. Assessment of functional ability of nonambulatory patients with obesity: after and before bariatric surgery. Surg Obes Relat Dis 2019; 15:2087-2093. [PMID: 31711943 DOI: 10.1016/j.soard.2019.09.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Functional ability is often impaired as a direct consequence of severe obesity. Bariatric surgery is the most effective treatment for severe obesity. OBJECTIVE To examine the effect of weight loss after bariatric surgery on patients with impaired functional ambulatory abilities due to obesity. SETTINGS A high-volume university-affiliated bariatric surgery center in India. METHOD We conducted a prospective study in a cohort of nonambulatory patients with functional disabilities (bedridden, wheelchair-bound, or walker-dependent) who underwent bariatric surgery. Data on sex, body mass index, co-morbid conditions, the severity of pain, and types of limitations in functional abilities were collected at baseline and at 1 year after bariatric surgery and analyzed. RESULTS Forty-five patients were enrolled in this study with 100% follow-up at 1 year. The mean age and body mass index of the patients were 54.7 ± 8.5 years and 54.2 ± 8.6 kg/m2, respectively. Thirty-four (75.5%) were female, 27 (60%) were walker-dependent, 14 (31.1%) were wheelchair-bound, and 4 (8.9%) were bedridden. At baseline 88.8% and 75.5% patients had severe knee and back pain, respectively. The percentage of total weight loss was 22% and 31% at 6 and 12 months, respectively. At 1 year, 37 (82.2%) patients were ambulating independently, only 1 (2.2%) patient was still bedridden, and 7 (15.5%) patients were walker-dependent. Mild, moderate, and severe classification on all functional ability scales were significantly improved. CONCLUSION Weight loss after bariatric surgery results in significant amelioration of knee and/or back pain with an improvement in functional abilities and quality of life.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India.
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India
| | - Prashant Salvi
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, Indore, Madhya Pradesh, India
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Benditz A, Sprenger S, Rauch L, Weber M, Grifka J, Straub RH. Increased pain and sensory hyperinnervation of the ligamentum flavum in patients with lumbar spinal stenosis. J Orthop Res 2019; 37:737-743. [PMID: 30747438 DOI: 10.1002/jor.24251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 02/05/2019] [Indexed: 02/04/2023]
Abstract
Nociceptive sensory nerve fibers have never been investigated in the ligamentum flavum (LF) of patients with LSS. The aim was to analyze nociceptive sensory nerve fibers in the ligamentum flavum (LF) of patients with LSS. A prospective study in patients with lumbar spinal stenosis (LSS) undergoing invasive surgical treatment for lumbar spinal stenosis (LSS) with flavectomy was performed. Patients with LSS were subjected to flavectomy and density of sensory and sympathetic nerve fibers, macrophages, vessels, activated fibroblasts, and cells were investigated by immunostaining techniques. A group of patients with acute disc herniation served as control group. We found a higher density of sensory nerve fibers in LSS patients versus controls. These findings support the role of LF in associated low back pain. Density of sensory nerve fibers in LSS, was positively correlated with typical markers of clinical pain and functional disability, but not with LF density of activated fibroblasts. Inflammation as estimated by macrophage infiltration and higher vascularity does not play a marked role in LF in our LSS patients. In the present study, compared to men with LSS, women with LSS demonstrate more pain and depression, and show a higher density of sensory nerve fibers in LF. This study shed new light on nociceptive nerve fibers, which are increased in LSS compared to controls. The findings speak against a strong inflammatory component in LSS. A higher pain levels in women compared to men can be explained by a higher density of nociceptive nerve fibers. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-7, 2019.
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Affiliation(s)
- Achim Benditz
- Department of Orthopedic Surgery, University Hospital Regensburg, Asklepios Clinic Bad Abbach, Kaiser Karl V. Allee 3, 93077, Bad Abbach, Germany
| | - Svenja Sprenger
- Department of Orthopedic Surgery, University Hospital Regensburg, Asklepios Clinic Bad Abbach, Kaiser Karl V. Allee 3, 93077, Bad Abbach, Germany.,Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine, University Hospital Regensburg, Regensburg, Bayern, Germany
| | - Luise Rauch
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine, University Hospital Regensburg, Regensburg, Bayern, Germany
| | - Markus Weber
- Department of Orthopedic Surgery, University Hospital Regensburg, Asklepios Clinic Bad Abbach, Kaiser Karl V. Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, University Hospital Regensburg, Asklepios Clinic Bad Abbach, Kaiser Karl V. Allee 3, 93077, Bad Abbach, Germany
| | - Rainer H Straub
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine, University Hospital Regensburg, Regensburg, Bayern, Germany
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Abstract
Low back pain (LBP) is common in adolescence, but there is a paucity of high-quality research to inform care. We conducted a multicenter randomized trial comparing 12 weeks of spinal manipulative therapy (SMT) combined with exercise therapy (ET) to ET alone. Participants were 185 adolescents aged 12 to 18 years with chronic LBP. The primary outcome was LBP severity at 12, 26, and 52 weeks. Secondary outcomes included disability, quality of life, medication use, patient- and caregiver-rated improvement, and satisfaction. Outcomes were analyzed using longitudinal linear mixed effect models. An omnibus test assessing differences in individual outcomes over the entire year controlled for multiplicity. Of the 185 enrolled patients, 179 (97%) provided data at 12 weeks and 174 (94%) at 26 and 52 weeks. Adding SMT to ET resulted in a larger reduction in LBP severity over the course of 1 year (P = 0.007). The group difference in LBP severity (0-10 scale) was small at the end of treatment (mean difference = 0.5; P = 0.08) but was larger at weeks 26 (mean difference = 1.1; P = 0.001) and 52 (mean difference = 0.8; P = 0.009). At 26 weeks, SMT with ET performed better than ET alone for disability (P = 0.04) and improvement (P = 0.02). The SMT with ET group reported significantly greater satisfaction with care at all time points (P ≤ 0.02). There were no serious treatment-related adverse events. For adolescents with chronic LBP, spinal manipulation combined with exercise was more effective than exercise alone over a 1-year period, with the largest differences occurring at 6 months. These findings warrant replication and evaluation of cost effectiveness.
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Salathé CR, Melloh M, Crawford R, Scherrer S, Boos N, Elfering A. Treatment Efficacy, Clinical Utility, and Cost-Effectiveness of Multidisciplinary Biopsychosocial Rehabilitation Treatments for Persistent Low Back Pain: A Systematic Review. Global Spine J 2018; 8:872-886. [PMID: 30560041 PMCID: PMC6293434 DOI: 10.1177/2192568218765483] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To review the current literature on the treatment efficacy, clinical utility, and cost-effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) for patients suffering from persistent (nonspecific) lower back pain (LBP) in relation to pain intensity, disability, health-related quality of life, and work ability/sick leave. METHODS We carried out a systematic search of Web of Science, Cochrane Library, PubMed Central, EMBASE, and PsycINFO for English- and German-language literature published between January 2010 and July 2017. Study selection consisted of exclusion and inclusion phases. After screening for duplication, studies were excluded on the basis of criteria covering study design, number of participants, language of publication, and provision of information about the intervention. All the remaining articles dealing with the efficacy, utility, or cost-effectiveness of intensive (more than 25 hours per week) MBR encompassing at least 3 health domains and cognitive behavioral therapy-based psychological education were included. RESULTS The search retrieved 1199 publications of which 1116 were duplicates or met the exclusion criteria. Seventy of the remaining 83 articles did not meet the inclusion criteria; thus 13 studies were reviewed. All studies reporting changes in pain intensity or disability over 12 months after MBR reported moderate effect sizes and/or p-values for both outcomes. The effects on health-related quality of life were mixed, but MBR substantially reduced costs. Overall MBR produced an enduring improvement in work ability despite controversy and variable results. CONCLUSIONS MBR is an effective treatment for nonspecific LBP, but there is room for improvement in cost-effectiveness and impact on sick leave, where the evidence was less compelling.
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Affiliation(s)
| | - Markus Melloh
- Zurich University of Applied Sciences, Winterthur, Switzerland
- Curtin University, Bentley, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia,
Australia
| | | | | | - Norbert Boos
- Prodorso Centre for Spinal Medicine, Zurich, Switzerland
| | - Achim Elfering
- University of Bern, Bern, Switzerland
- University of Geneva, Geneva, Switzerland
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Morelhão PK, Franco MR, Oliveira CB, Hisamatsu TM, Ferreira PH, Costa LOP, Maher CG, Pinto RZ. Physical activity and disability measures in chronic non-specific low back pain: a study of responsiveness. Clin Rehabil 2018; 32:1684-1695. [DOI: 10.1177/0269215518787015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To compare the responsiveness of disability measures with physical activity measures in patients with chronic low back pain (CLBP) undergoing a course of physical therapy treatment. Design: This is a prospective cohort study with two-month follow-up. Subjects: A total of 106 patients presenting with non-specific CLBP of more than three months duration were recruited. Main measures: Disability measures investigated were Quebec Back Pain Disability Scale and Roland Morris Disability Questionnaire. Physical activity measures analyzed include the Baecke Habitual Physical Activity Questionnaire and objective measures derived from an accelerometer (i.e. total time spent in moderate-to-vigorous and light physical activity, number of steps and counts per minute). Disability and physical activity measures were collected at the baseline and after eight weeks of treatment. For the responsiveness analyses, effect size (ES) and standardized response mean (SRM) were calculated. Correlations between the change in disability and physical activity measures were calculated. Results: Responsiveness for disability measures was considered to be large with ESs ranging from −1.03 to −1.45 and SRMs ranging from −0.99 to −1.34, whereas all physical activity measures showed values lower than 0.20. Changes in disability measures did not correlate with changes in physical activity measures (correlation coefficients ranged from −0.10 to 0.09). Conclusion: Disability measures were responsive after a course of physical therapy treatment in patients with CLBP. The lack of responsiveness in the physical activity measures might be due to the inability of these measures to detect change over time or the use of an intervention not designed to increase physical activity levels.
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Affiliation(s)
- Priscila K Morelhão
- Department of Physical Therapy, Faculty of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Márcia R Franco
- Department of Physical Therapy, Centro Universitário UNA, Contagem, Brazil
| | - Crystian B Oliveira
- Department of Physical Therapy, Faculty of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Thalysi M Hisamatsu
- Department of Physical Therapy, Faculty of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Science, The University of Sydney, Sydney, Australia
| | - Leonardo OP Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Chris G Maher
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Rafael Zambelli Pinto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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A Comparison of Back Pain Functional Scale With Roland Morris Disability Questionnaire, Oswestry Disability Index, and Short Form 36-Health Survey. Spine (Phila Pa 1976) 2018; 43:877-882. [PMID: 28984734 DOI: 10.1097/brs.0000000000002431] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A comparison study of Back Pain Functional Scale (BPFS) with Roland Morris Questionnaire (RMQ), Oswestry Disability Index (ODI), and Short Form 36-Health Survey (SF-36). OBJECTIVE The aim of this study is to investigate the correlation of BPFS with RMQ, ODI, and SF-36. SUMMARY OF BACKGROUND DATA The primary goal in the treatment of patients with low back pain is to improve the patients' levels of activities and participation. Many questionnaires focusing on function have been developed in patients with low back pain. BPFS is one of these questionnaires. No studies have investigated the correlation of BPFS with ODI and SF-36. METHODS This study was conducted with 120 patients receiving outpatient and inpatient treatment in physiotherapy and rehabilitation units of a state hospital. BPFS, RMQ, ODI, and SF-36 questionnaires were used to assess the disability in low back pain. Spearman and Pearson Correlation were used to compare the data obtained in the study. RESULTS There was a good correlation among the 5 functional outcome measures (correlation r = -0.693 for BPFS/RMQ, r = -0.794 for BPFS/ODI, r = 0.697 for BPFS/SF-36 Physical function and r = 0.540 for BPFS/SF-36 Pain). CONCLUSION BPFS demonstrated good correlation with RMQ, ODI, SF-36 physical function, and SF-36 pain. LEVEL OF EVIDENCE 2.
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Goldsmith ES, Taylor BC, Greer N, Murdoch M, MacDonald R, McKenzie L, Rosebush CE, Wilt TJ. Focused Evidence Review: Psychometric Properties of Patient-Reported Outcome Measures for Chronic Musculoskeletal Pain. J Gen Intern Med 2018; 33:61-70. [PMID: 29633142 PMCID: PMC5902346 DOI: 10.1007/s11606-018-4327-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Developing successful interventions for chronic musculoskeletal pain requires valid, responsive, and reliable outcome measures. The Minneapolis VA Evidence-based Synthesis Program completed a focused evidence review on key psychometric properties of 17 self-report measures of pain severity and pain-related functional impairment suitable for clinical research on chronic musculoskeletal pain. METHODS Pain experts of the VA Pain Measurement Outcomes Workgroup identified 17 pain measures to undergo systematic review. In addition to a MEDLINE search on these 17 measures (1/2000-1/2017), we hand-searched (without publication date limits) the reference lists of all included studies, prior systematic reviews, and-when available-Web sites dedicated to each measure (PROSPERO registration CRD42017056610). Our primary outcome was the measure's minimal important difference (MID). Secondary outcomes included responsiveness, validity, and test-retest reliability. Outcomes were synthesized through evidence mapping and qualitative comparison. RESULTS Of 1635 abstracts identified, 331 articles underwent full-text review, and 43 met inclusion criteria. Five measures (Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), SF-36 Bodily Pain Scale (SF-36 BPS), Numeric Rating Scale (NRS), and Visual Analog Scale (VAS)) had data reported on MID, responsiveness, validity, and test-retest reliability. Seven measures had data reported on three of the four psychometric outcomes. Eight measures had reported MIDs, though estimation methods differed substantially and often were not clinically anchored. CONCLUSIONS In this focused evidence review, the most evidence on key psychometric properties in chronic musculoskeletal pain populations was found for the ODI, RMDQ, SF-36 BPS, NRS, and VAS. Key limitations in the field include substantial variation in methods of estimating psychometric properties, defining chronic musculoskeletal pain, and reporting patient demographics. TRIAL REGISTRATION Registered in the PROSPERO database: CRD42017056610.
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Affiliation(s)
- Elizabeth S Goldsmith
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA. .,Section General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA. .,University of Minnesota School of Public Health, Minneapolis, MN, USA.
| | - Brent C Taylor
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of Minnesota School of Public Health, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nancy Greer
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Maureen Murdoch
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.,Section General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
| | - Roderick MacDonald
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Lauren McKenzie
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Christina E Rosebush
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Timothy J Wilt
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.,Section General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
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Accelerometer-Determined Physical Activity and Clinical Low Back Pain Measures in Adolescents With Chronic or Subacute Recurrent Low Back Pain. J Orthop Sports Phys Ther 2017; 47:769-774. [PMID: 28898136 PMCID: PMC5639712 DOI: 10.2519/jospt.2017.7345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional. Background Although low back pain (LBP) occurs commonly in adolescence, little is known about the relationship between objectively measured physical activity and chronic LBP. Objectives To assess the relationship between an objective physical activity measure (accelerometer) and standard clinical measures (pain intensity, disability, and quality of life) in a sample of adolescents with recurrent or chronic LBP. Methods The study included a subsample of 143 adolescents, 12 to 18 years of age, from a randomized clinical trial. Pearson correlations (r) and bivariate linear regression were used to assess the relationship between baseline measures of sedentary, light, and moderate-to-vigorous physical activity using accelerometers and clinical measures of LBP (pain intensity, disability, and quality of life). Results Participants spent an average of 610.5 minutes in sedentary activity, 97.6 minutes in light physical activity, and 35.6 minutes in moderate-to-vigorous physical activity per day. Physical activity was very weakly associated with clinical measures of LBP (r<0.13). None of the assessed correlations were statistically significant, and bivariate regression models showed that physical activity measures explained very little of the variability for clinical measures of LBP (R2<0.02). Conclusion We found no important relationship between objectively measured physical activity and self-reported LBP intensity, disability, or quality of life in adolescents with recurrent or chronic LBP. The parent randomized clinical trial was registered at ClinicalTrials.gov (NCT01096628). J Orthop Sports Phys Ther 2017;47(10):769-774. Epub 12 Sep 2017. doi:10.2519/jospt.2017.7345.
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The Roland–Morris Disability Questionnaire: one or more dimensions? 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 2016; 26:301-308. [DOI: 10.1007/s00586-016-4890-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 10/11/2016] [Accepted: 11/15/2016] [Indexed: 11/27/2022]
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A randomized double-blind, placebo-controlled efficacy and safety study of ALO-02 (extended-release oxycodone surrounding sequestered naltrexone) for moderate-to-severe chronic low back pain treatment. Pain 2016; 156:1660-1669. [PMID: 25993547 DOI: 10.1097/j.pain.0000000000000230] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this multicenter, double-blind, placebo-controlled, randomized withdrawal study was to evaluate the efficacy and safety of ALO-02, an abuse-deterrent formulation containing pellets of extended-release oxycodone hydrochloride (HCl) surrounding sequestered naltrexone HCl, compared with placebo in the treatment of moderate-to-severe chronic low back pain. An open-label titration period in which all patients received ALO-02 was followed by a double-blind treatment period where patients meeting treatment response criteria were randomized to either a fixed dose of ALO-02 or placebo. Daily average low back pain was assessed using an 11-point numeric rating scale (NRS)-Pain. Of the 663 patients screened, 410 received ALO-02 during the open-label conversion and titration period and 281 patients were randomized to the double-blind treatment period (n = 134, placebo; n = 147, ALO-02). Change in the mean NRS-Pain score from randomization baseline to the final 2 weeks of the treatment period was significantly different favoring ALO-02 compared with placebo (P = 0.0114). Forty-four percent of patients treated with placebo and 57.5% of patients treated with ALO-02 reported ≥30% improvement in weekly average NRS-Pain scores from screening to the final 2 weeks of the treatment period (P = 0.0248). In the double-blind treatment period, 56.8% of patients in the ALO-02 group and 56.0% of patients in the placebo group experienced a treatment-emergent adverse event (TEAE). The most common treatment-related TEAEs for ALO-02 during the treatment period were nausea, vomiting, and constipation, consistent with opioid therapy. ALO-02 has been demonstrated to provide significant reduction of pain in patients with chronic low back pain and has a safety profile similar to other opioids.
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Ramke S, Sharpe L, Newton-John T. Adjunctive cognitive behavioural treatment for chronic pain couples improves marital satisfaction but not pain management outcomes. Eur J Pain 2016; 20:1667-1677. [DOI: 10.1002/ejp.890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 11/09/2022]
Affiliation(s)
- S. Ramke
- School of Psychology; University of Sydney; Australia
| | - L. Sharpe
- School of Psychology; University of Sydney; Australia
| | - T. Newton-John
- Graduate School of Health; University of Technology Sydney; Australia
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Felício DC, Pereira DS, de Queiroz BZ, da Silva JP, Leopoldino AAO, Pereira LSM. Kinesiophobia is not associated with disability in elderly women with acute low back pain: Back Complaints in the Elders (BACE) Brazil study results. Spine J 2016; 16:619-25. [PMID: 26780753 DOI: 10.1016/j.spinee.2016.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/01/2015] [Accepted: 01/01/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The study of low back pain (LBP) is complex, and the physical and psychological aspects, including kinesiophobia, should be considered. Several studies have investigated the relationship between kinesiophobia and functionality in patients with chronic LBP. However, to the best of the authors' knowledge, no studies have investigated the association between kinesiophobia and self-reported assessments of disability and physical performance in elderly patients with acute LBP. PURPOSE The study aimed to investigate the association between kinesiophobia and self-reported and physical performance measures among the elderly with acute LBP. DESIGN This was an observational, cross-sectional, ancillary study of the Back Complaints in the Elders study, a longitudinal observational epidemiologic research project by an international consortium involving Brazil, the Netherlands, and Australia. PATIENT SAMPLE Sample selection was carried out by convenience. The study included women from the community aged 60 years old and older who presented with a new episode of LBP. Volunteers with severe diseases, as well as visual, hearing, and mobility losses, or cognitive dysfunction, were excluded. Four hundred fifty nine elderly women (mean age: 69.0±6.1 years) were included. OUTCOME MEASURES Kinesiophobia was evaluated by Fear Avoidance Beliefs Questionnaire (FABQ), subscale FABQ-Phys. Functionality was investigated by the Roland-Morris Questionnaire and the gait speed test. METHODS Statistical analysis was performed using hierarchical linear regression model. Statistical significance was established at the level of .05. RESULTS The additional predictive value because of the inclusion of the FABQ-Phys was 0.1%, using the Roland-Morris score, and 0.2% for the gait speed test. CONCLUSIONS This was the first study to investigate the association between the FABQ-Phys and functionality in elderly patients with acute LBP. The results provide preliminary evidence that kinesiophobia assessed by the FABQ-Phys cannot be generalized to disability.
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Affiliation(s)
- Diogo C Felício
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil; Universidade Federal de Juiz de Fora, São Pedro, 36036-900 Juiz de Fora, MG, Brazil.
| | - Daniele S Pereira
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
| | - Barbara Z de Queiroz
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
| | - Juscelio P da Silva
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
| | - Amanda A O Leopoldino
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
| | - Leani S M Pereira
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
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Nayak NR, Coats JM, Abdullah KG, Stein SC, Malhotra NR. Tracking patient-reported outcomes in spinal disorders. Surg Neurol Int 2015; 6:S490-9. [PMID: 26605111 PMCID: PMC4617013 DOI: 10.4103/2152-7806.166892] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/24/2015] [Indexed: 11/22/2022] Open
Abstract
Background: Patient-reported outcome measures (PROMs) quantify health status from the patient's point of view. While the number of published outcomes studies grows each year, so too has the number of instruments being reported, leading to confusion on which instruments are appropriate to use for various spinal conditions. Methods: A broad search was conducted to identify commonly used PROMs in patients undergoing spinal surgery. We searched PubMed for combinations of terms related to anatomic location and a measure of patient-reported outcome in the title or text. We supplemented the search using the “related articles” feature of PubMed and by manually searching the bibliographies of selected articles. Results: Major categories of PROMs in spine surgery include health-related quality-of-life, pain, and disease-specific disability, for which several different instrument options were identified and detailed. The minimal clinically important difference varies between instruments and differentiates statistical significance from clinical significance. In addition, the accurate estimation of costs has become a challenging but intrinsically linked variable to outcomes as increased attention is paid to the relative value of surgical interventions. Conclusion: While a number of PROMs are available for tracking outcomes in spine surgery, only a handful appear to be widely used. At least one instrument from each category should be measured pre- and post-operatively to quantify treatment effect. In addition, while the primary goal is to select the most appropriate instruments for the patient's condition, one should keep in mind sustainability of efforts with regard to patient and administrative burden.
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Affiliation(s)
- Nikhil R Nayak
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John Mitchell Coats
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kalil G Abdullah
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sherman C Stein
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Spinal manipulation and exercise for low back pain in adolescents: study protocol for a randomized controlled trial. Chiropr Man Therap 2014; 22:21. [PMID: 24904748 PMCID: PMC4046145 DOI: 10.1186/2045-709x-22-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background Low back pain is among the most common and costly chronic health care conditions. Recent research has highlighted the common occurrence of non-specific low back pain in adolescents, with prevalence estimates similar to adults. While multiple clinical trials have examined the effectiveness of commonly used therapies for the management of low back pain in adults, few trials have addressed the condition in adolescents. The purpose of this paper is to describe the methodology of a randomized clinical trial examining the effectiveness of exercise with and without spinal manipulative therapy for chronic or recurrent low back pain in adolescents. Methods/design This study is a randomized controlled trial comparing twelve weeks of exercise therapy combined with spinal manipulation to exercise therapy alone. Beginning in March 2010, a total of 184 participants, ages 12 to 18, with chronic or recurrent low back pain are enrolled across two sites. The primary outcome is self-reported low back pain intensity. Other outcomes include disability, quality of life, improvement, satisfaction, activity level, low back strength, endurance, and motion. Qualitative interviews are conducted to evaluate participants’ perceptions of treatment. Discussion This is the first randomized clinical trial assessing the effectiveness of combining spinal manipulative therapy with exercise for adolescents with low back pain. The results of this study will provide important evidence on the role of these conservative treatments for the management of low back pain in adolescents. Trial registration (ClinicalTrials.gov NCT01096628).
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Abstract
BACKGROUND The Pain Self-Efficacy Questionnaire (PSEQ) is used by physical therapists in clinical practice and in research. However, current understanding of the PSEQ's measurement properties is incomplete, and investigators cannot be confident that it provides unbiased information on patient self-efficacy. OBJECTIVE The aims of this study were: (1) to investigate the scale properties of the PSEQ using Rasch analysis and (2) to determine whether age, sex, pain intensity, pain duration, and pain-related disability bias function of the PSEQ. DESIGN This was a retrospective study; data were obtained from 3 existing studies. METHODS Data were combined from more than 600 patients with low back pain of varying duration. Rasch analysis was used to evaluate targeting, category ordering, unidimensionality, person fit, internal consistency, and item bias. RESULTS There was evidence of adequate category ordering, unidimensionality, and internal consistency of the PSEQ. Importantly, there was no evidence of item bias. LIMITATIONS The PSEQ did not adequately target the sample; instead, it targeted people with lower self-efficacy than this population. Item 7 was hardest for participants to endorse, showing excessive positive misfit to the Rasch model. Response strings of misfitting persons revealed older participants and those reporting high levels of disability. CONCLUSIONS The individual items of the PSEQ can be validly summed to provide a score of self-efficacy that is robust to age, sex, pain intensity, pain duration, and disability. Although item 7 is the most problematic, it may provide important clinical information and requires further investigation before its exclusion. Although the PSEQ is commonly used with people with low back pain, of whom the sample in this study was representative, the results suggest it targets patients with lower self-efficacy than that observed in the current sample.
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