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Budzisz A, Jung A, Adamczyk WM, Szikszay TM, Carvalho GF, Bąbel P, Luedtke K. Body Image Measured via the Fremantle Awareness Questionnaire in Individuals With and Without Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2024; 25:104530. [PMID: 38599266 DOI: 10.1016/j.jpain.2024.104530] [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: 10/31/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
Research suggests that pain negatively affects body image, and body image may also influence reported pain levels. This review aims to summarize the literature on differences in body image distortion between individuals with pain compared to pain-free individuals. The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement and an a priori preregistered protocol. The literature was searched using 5 electronic databases. Studies assessing body image with the Fremantle Awareness Questionnaire (FAQ) in individuals with and without pain were eligible for inclusion. Screening and selection of eligible studies were performed by independent reviewers. Methodological quality was assessed with the Joanna Briggs Institute critical appraisal tool. Meta-analyses, meta-correlations, and metamean analyses were performed using random-effect models. The primary outcome was the FAQ score; secondary outcomes were reported pain variables. Data from individuals with pain (n = 2277) and without pain (n = 615) were summarized. Significant body image distortions were found in individuals with pain compared to individuals without pain. Compared to pain-free individuals, the pain group rated significantly higher in the FAQ when experiencing back pain (standardized mean differences=1.33, 95% confidence interval=.88-1.77) or other body parts (standardized mean differences=1.25, 95% confidence interval=.51-1.99). The results of meta-correlation analyses confirmed the positive relationship between body image distortion and pain intensity (r = .31), pain at rest (r = .31), or pain during movement (r = .36), but not for pain duration. A difference in mean FAQ results was observed between individuals with pain in different areas (knee and back). PERSPECTIVE: This review confirms differences in body image distortion between pain and pain-free individuals. Pain intensity was correlated with altered body perception, but not pain duration. A moderate correlation was observed between body image distortion and reported pain variables. Body image was more impaired by knee pain than back pain. REGISTERED PROTOCOL AT PROSPERO: CRD42022309937; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022309937.
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Affiliation(s)
- Aleksandra Budzisz
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland.
| | - Andres Jung
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Waclaw M Adamczyk
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Tibor M Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Luebeck, Germany
| | - Gabriela F Carvalho
- Department of Physiotherapy, Faculty of Health, Safety and Society, Furtwangen University, Furtwangen, Germany
| | - Przemysław Bąbel
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Luebeck, Germany
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Phongsaphakjarukorn N, Kanlayanaphotporn R, Jensen MP, Janwantanakul P. Responsiveness and clinically important differences of the PROMIS short form-depression 8a, anxiety 8a, and PASS-20 in individuals with chronic low back pain. Pain Rep 2024; 9:e1170. [PMID: 38910868 PMCID: PMC11191038 DOI: 10.1097/pr9.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/30/2024] [Accepted: 05/14/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Depression and anxiety are the most commonly reported mental health conditions. The Patient-Reported Outcomes Measurement Information System Short Form v1.0-Depression 8a (PROMIS-D-8a), Anxiety 8a (PROMIS-Anx8a), and Pain Anxiety Symptoms Scale-20 (PASS-20) measures were designed to assess depression, general anxiety, and pain-related anxiety, respectively. Objectives To examine the responsiveness and estimate the clinically important differences (CIDs) of the Thai version of these measures in individuals with chronic low back pain (CLBP). Methods The study sample comprised 144 participants with CLBP. Responsiveness was evaluated by calculating the change scores, effect sizes (ESs), standardized response means (SRMs), area under the curve (AUC), and correlations between the change scores and associated Global Perceived Effect (GPE). We also estimated CIDs by the difference in mean change score between improved and unchanged groups and standard error of measurement (SEM) for each measure. Results Statistically significant differences in the mean change scores, ESs, and SRMs supported the responsiveness of all measures. The AUCs achieved acceptable discriminatory ability (0.71-0.72) for moderate improvement but not for any improvement (0.65-0.68). The correlations between GPE and change scores on all measures were low (r ranging 0.28-0.33). The estimated CIDs for the PROMIS-D-8a, PROMIS-Anx8a, and PASS-20 were 3.64, 4.20, and 8.80, respectively. Conclusion The PROMIS-D-8a, PROMIS-Anx8a, and PASS-20 measures were sensitive for detecting clinical changes over time in individuals with CLBP. The CID values can be used as reference points for assessing meaningful improvements in the domains assessed by these scales in clinical and research practice.
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Affiliation(s)
| | - Rotsalai Kanlayanaphotporn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Prawit Janwantanakul
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Chen J, Huang Y, Yang Y, Wang Z, Zhao D, Luo M, Pu F, Yang J, Zhang Z, He B. Vertebral bone quality score was associated with paraspinal muscles fat infiltration, but not modic classification in patients with chronic low back pain: a prospective cross-sectional study. BMC Musculoskelet Disord 2024; 25:509. [PMID: 38956545 PMCID: PMC11221129 DOI: 10.1186/s12891-024-07626-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The lumbar vertebra and paraspinal muscles play an important role in maintaining the stability of the lumbar spine. Therefore, the aim of this study was to investigate the relationship between paraspinal muscles fat infiltration and vertebral body related changes [vertebral bone quality (VBQ) score and Modic changes (MCs)] in patients with chronic low back pain (CLBP). METHODS Patients with CLBP were prospectively collected in four hospitals and all patients underwent 3.0T magnetic resonance scanning. Basic clinical information was collected, including age, sex, course of disease (COD), and body mass index (BMI). MCs were divided into 3 types based on their signal intensity on T1 and T2-weighted imaging. VBQ was obtained by midsagittal T1-weighted imaging (T1WI) and calculated using the formula: SIL1-4/SICSF. The Proton density fat fraction (PDFF) values and cross-sectional area (CSA) of paraspinal muscles were measured on the fat fraction map from the iterative decomposition of water and fat with the echo asymmetry and least-squares estimation quantitation (IDEAL-IQ) sequences and in/out phase images at the central level of the L4/5 and L5/S1 discs. RESULTS This study included 476 patients with CLBP, including 189 males and 287 females. 69% had no Modic changes and 31% had Modic changes. There was no difference in CSA and PDFF for multifidus(MF) and erector spinae (ES) at both levels between Modic type I and type II, all P values>0.05. Spearman correlation analysis showed that VBQ was weakly negatively correlated with paraspinal muscles CSA (all r values < 0.3 and all p values < 0.05), moderately positive correlation with PDFF of MF at L4/5 level (r values = 0.304, p values<0.001) and weakly positively correlated with PDFF of other muscles (all r values<0.3 and all p values<0.001). Multivariate linear regression analysis showed that age (β = 0.141, p < 0.001), gender (β = 4.285, p < 0.001) and VBQ (β = 1.310, p = 0.001) were related to the total PDFF of muscles. For MCs, binary logistic regression showed that the odds ratio values of age, BMI and COD were 1.092, 1.082 and 1.004, respectively (all p values < 0.05). CONCLUSIONS PDFF of paraspinal muscles was not associated with Modic classification. In addition to age and gender, PDFF of paraspinal muscles is also affected by VBQ. Age and BMI are considered risk factors for the MCs in CLBP patients.
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Grants
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
- (No. 202201AC070669, 202201AU070051, 202301AS070016, 202001AY070001-200)and(No. 82260338). Yunnan Fundamental Research Projects and the National Natural Science Foundation of China
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Affiliation(s)
- Jiaxin Chen
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, 50032, China
| | - Yilong Huang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, 50032, China
| | - Yingjuan Yang
- Department of Radiology, Dali Bai Autonomous Prefecture People's Hospital, Dali, 671099, China
| | - Zhongwei Wang
- Department of Radiology, Baoshan People's Hospital, Baoshan, 678099, China
| | - Derong Zhao
- Department of Radiology, Baoshan People's Hospital, Baoshan, 678099, China
| | - Mingbin Luo
- Department of Radiology, The First People's Hospital of Honghe State, Mengzi, 661199, China
| | - Fushun Pu
- Department of Radiology, The First People's Hospital of Honghe State, Mengzi, 661199, China
| | - Juntao Yang
- Department of Radiology, Dali Bai Autonomous Prefecture People's Hospital, Dali, 671099, China.
| | - Zhenguang Zhang
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, 50032, China.
| | - Bo He
- Department of Medical Imaging, the First Affiliated Hospital of Kunming Medical University, Kunming, 50032, China.
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Shockey T, Alterman T, Yang H, Lu ML. Workplace Psychosocial Factors, Work Organization, and Physical Exertion as Risk Factors for Low Back Pain Among US Workers: Data From the 2015 National Health Interview Survey. J Occup Environ Med 2024; 66:467-474. [PMID: 38471812 DOI: 10.1097/jom.0000000000003087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To evaluate the association between workplace psychosocial, organization, and physical risk factors with low back pain (LBP) among US workers. METHODS 2015 National Health Interview Survey data were analyzed to calculate the prevalence rates and prevalence ratios for LBP across levels of workplace psychosocial and organizational risk factors among 17,464 US adult workers who worked ≥20 hours per week. Results were also stratified by workplace physical exertion. RESULTS The adjusted prevalence rates of LBP were significantly elevated for workers reporting high job demand, low job control, work-family imbalance, bullying, job insecurity, working alternate shifts, and physical exertion. Job control and nonstandard shifts were significantly associated with LBP only among those who reported low/no physical exertion. CONCLUSIONS LBP prevalence was associated with select workplace psychosocial and organization risk factors. Stratification by physical exertion modified multiple associations.
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Affiliation(s)
- Taylor Shockey
- From the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio (T.S., T.A., M.-L.L.); and University of California-Irvine, School of Medicine, Irvine, California (H.Y.)
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Hue TF, Lotz JC, Zheng P, Black DM, Bailey J, Ewing SK, Fields AJ, Mehling W, Scheffler A, Strigo I, Petterson T, Wu LA, O'Neill C. Design of the COMEBACK and BACKHOME Studies, Longitudinal Cohorts for Comprehensive Deep Phenotyping of Adults with Chronic Low-Back Pain (cLBP): a part of the BACPAC Research Program. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.09.24305574. [PMID: 38645207 PMCID: PMC11030474 DOI: 10.1101/2024.04.09.24305574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Objective The University of California, San Francisco (UCSF) Core Center for Patient-centric, Mechanistic Phenotyping in Chronic Low Back Pain (REACH) is one of the three NIH Back Pain Consortium (BACPAC) Research Programs Mechanistic Research Centers (MRCs). The goal of UCSF REACH is to define cLBP phenotypes and pain mechanisms that can lead to effective, personalized treatments for patients across the population. The primary objective of this research project is to address the critical need for new diagnostic and prognostic markers, and associated patient classification protocols for chronic low back pain (cLBP) treatment. Design To meet this objective, REACH is conducting two large investigator-initiated translational research cohort studies called: The Longitudinal Clinical Cohort for Comprehensive Deep Phenotyping of Chronic Low-Back Pain (cLBP) Adults Study (comeBACK) and the Chronic Low-Back Pain (cLBP) in Adults Study (BACKHOME). Setting comeBACK is a longitudinal multicenter in-person observational study of 450 adults with chronic low back pain designed to perform comprehensive deep phenotyping. While, the BACKHOME study is a site-less longitudinal observational e-cohort of approximately 3000 U.S. adults with cLBP. To our knowledge, BACKHOME is the largest prospective remote registry of nationwide adults with cLBP. Methods Both the comeBACK and BACKHOME studies are collecting a robust and comprehensive set of risk factors, outcomes, and covariates in order to perform deep phenotyping of cLBP patients based on combined biopsychosocial variables to: define cLBP subtypes, establish phenotyping tools for routine clinical evaluation, and lead to improved cLBP outcomes in the future. The data from both studies will be used to establish techniques to develop a patient-centric definition of treatment success and to analyze cLBP patient traits to define clinically useful cLBP phenotypes, using a combination of traditional data analyses and deep learning methods. Conclusions These 2 pivotal studies, in conjunction with the ancillary studies being performed in both comeBACK and BACKHOME, and the other BACPAC-consortium research projects, we will be able to address a number of diagnostic and therapeutic issues in this complex and diverse patient population with cLBP. These studies will help clarify biopsychosocial mechanisms of cLBP with the aim to provide a foundation to improve the evaluation of treatment effectiveness and to spur new avenues of therapeutic research, including personalized outcome measures that constitute a clinically meaningful treatment effect for individual cLBP patients.
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Butowicz CM, Golyski PR, Acasio JC, Hendershot BD. Comparing spinal loads in individuals with unilateral transtibial amputation with and without chronic low back pain: An EMG-informed approach. J Biomech 2024; 166:111966. [PMID: 38373872 DOI: 10.1016/j.jbiomech.2024.111966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Abstract
Chronic low back pain (cLBP) is highly prevalent after lower limb amputation (LLA), likely due in part to biomechanical factors. Here, three-dimensional full-body kinematics and kinetics during level-ground walking, at a self-selected and three controlled speeds (1.0, 1.3, and 1.6 m/s), were collected from twenty-one persons with unilateral transtibial LLA, with (n = 9) and without cLBP (n = 12). Peak compressive, mediolateral, and anteroposterior L5-S1 spinal loads were estimated from a full-body, transtibial amputation-specific OpenSim model and compared between groups. Predicted lumbar joint torques from muscle activations were compared to inverse dynamics and predicted and measured electromyographic muscle activations were compared for model evaluation and verification. There were no group differences in compressive or anterior shear forces (p > 0.466). During intact stance, peak ipsilateral loads increased with speed to a greater extent in the cLBP group vs. no cLBP group (p=0.023), while during prosthetic stance, peak contralateral loads were larger in the no cLBP group (p=0.047) and increased to a greater extent with walking speed compared to the cLBP group (p=0.008). During intact stance, intact side external obliques had higher activations in the no cLBP group (p=0.039), and internal obliques had higher activations in the cLBP group at faster walking speeds compared to the no cLBP group. Predicted muscle activations demonstrated similar activation patterns to electromyographic-measured activations (r = 0.56-0.96), and error between inverse dynamics and simulated spinal moments was low (0.08 Nm RMS error). Persons with transtibial LLA and cLBP may adopt movement strategies during walking to reduce mediolateral shear forces at the L5-S1 joint, particularly as walking speed increases. However, future work is needed to understand the time course from pain onset to chronification and the cumulative influence of increased spinal loads over time.
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Affiliation(s)
- Courtney M Butowicz
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States; Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
| | - Pawel R Golyski
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States
| | - Julian C Acasio
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States
| | - Brad D Hendershot
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States; Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States
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Kicherova OA, Klimov GJ, Reikhert LI, Skrjabin EG. [Features of pain syndrome in vertebrogenic pathology in women]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:14-21. [PMID: 38884425 DOI: 10.17116/jnevro202412405114] [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] [Indexed: 06/18/2024]
Abstract
Pain syndrome is one of the important problems faced by women, and its treatment requires an integrated approach, taking into account the individual characteristics of the female body. Currently, several hypotheses have been formulated to explain sex differences in the perception of pain, but they all have a number of contradictions. It has been established that pain syndrome occurs more often in women than in men and its prevalence increases with age. The characteristics of pain syndrome in women are based on hormonal fluctuations during menstruation, changes associated with pregnancy, menopause, anatomical aspects, as well as psycho-social factors. An analysis of studies of non-drug methods of treating vertebrogenic pain syndrome (acupuncture, manual therapy, physical methods) is presented from the point of view of sex differences in their effectiveness. In female patients, the effectiveness of such therapy is shown to be generally higher than in men, and the percentage of pain relapses is lower. Also, women are more likely than men to use methods to prevent chronic pain syndrome. The features of vertebrogenic pain syndrome during pregnancy, as well as the effectiveness of medical and surgical treatment methods in patients of both sexes, are separately considered. Thus, taking into account the individual characteristics of vertebrogenic pain syndrome and its response to various treatment methods in women contributes to the development of effective comprehensive rehabilitation programs for this category of patients.
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Affiliation(s)
- O A Kicherova
- Tyumen State Medical University, Tyumen Russi, Tyumen State Medical University, Tyumen Russia
| | - G Ju Klimov
- Tyumen State Medical University, Tyumen Russi, Tyumen State Medical University, Tyumen Russia
| | - L I Reikhert
- Tyumen State Medical University, Tyumen Russi, Tyumen State Medical University, Tyumen Russia
| | - E G Skrjabin
- Tyumen State Medical University, Tyumen Russi, Tyumen State Medical University, Tyumen Russia
- Regional Clinical Hospital No. 2, Tyumen, Russia
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Bizzoca D, Solarino G, Pulcrano A, Brunetti G, Moretti AM, Moretti L, Piazzolla A, Moretti B. Gender-Related Issues in the Management of Low-Back Pain: A Current Concepts Review. Clin Pract 2023; 13:1360-1368. [PMID: 37987423 PMCID: PMC10660510 DOI: 10.3390/clinpract13060122] [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: 07/01/2023] [Revised: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is an emerging disease. This review aims to investigate the role of gender-related factors in the diagnosis, clinical, and surgical management of LBP. METHODS From January 2002 to March 2023, EMBASE, SCOPUS, OVID-MEDLINE, Google Scholar, PubMed, and Web of Science were searched to identify relevant papers for further analysis. RESULTS Fifteen papers were included in this review. Sex- and gender-related differences were analyzed regarding the following points: (1) LBP epidemiology; (2) LBP physiopathology; (3) conservative management of LBP; (4) major vertebral surgery for LBP. The conservative treatment of LBP highlights that women claim services later in terms of poorer health status than men. In the postoperative phase, female patients show worse LBP, quality of life, and disability, but equal or greater interval change, compared with male patients complaining of lumbar degenerative disease. CONCLUSIONS LBP epidemiology and clinical outcomes, following conservative and surgical management of patients complaining of back pain, might depend on both sex- and gender-related factors. It is mandatory to assess gender-related indicators in patients referred to LBP and address them to improve their clinical outcomes and quality of life.
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Affiliation(s)
- Davide Bizzoca
- UOSD Vertebral Surgery, AOU Consorziale Policlinico di Bari, 70124 Bari, Italy;
- Ph.D. Course in Public Health, Clinical Medicine and Oncology, Department DiMePre-J, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Giuseppe Solarino
- Orthopedics Unit, Department of Translational Biomedicine and Neuroscience “DiBraiN”, School of Medicine and Surgery, University of Bari, General Hospital, 70124 Bari, Italy; (G.S.); (B.M.)
| | - Alessandro Pulcrano
- Orthopedics Unit, Department of Translational Biomedicine and Neuroscience “DiBraiN”, School of Medicine and Surgery, University of Bari, General Hospital, 70124 Bari, Italy; (G.S.); (B.M.)
| | - Giovanni Brunetti
- Orthopedics Unit, Department of Translational Biomedicine and Neuroscience “DiBraiN”, School of Medicine and Surgery, University of Bari, General Hospital, 70124 Bari, Italy; (G.S.); (B.M.)
| | - Anna Maria Moretti
- Department of Pneumology, Santa Maria Hospital, Via De Ferrariis 18/D, 70124 Bari, Italy
| | - Lorenzo Moretti
- Orthopedics Unit, Department of Translational Biomedicine and Neuroscience “DiBraiN”, School of Medicine and Surgery, University of Bari, General Hospital, 70124 Bari, Italy; (G.S.); (B.M.)
| | - Andrea Piazzolla
- UOSD Vertebral Surgery, AOU Consorziale Policlinico di Bari, 70124 Bari, Italy;
| | - Biagio Moretti
- Orthopedics Unit, Department of Translational Biomedicine and Neuroscience “DiBraiN”, School of Medicine and Surgery, University of Bari, General Hospital, 70124 Bari, Italy; (G.S.); (B.M.)
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Doorenbos AZ, Schlaeger JM, deMartelly VA, Burke LA, Boyd AD, Knisely MR, Leigh JW, Li H, Mandernach MW, Molokie RE, Patil CL, Steffen AD, Shah N, Ezenwa MO. Hybrid effectiveness-implementation trial of guided relaxation and acupuncture for chronic sickle cell disease pain (GRACE): A protocol. Contemp Clin Trials Commun 2023; 32:101076. [PMID: 36852100 PMCID: PMC9958255 DOI: 10.1016/j.conctc.2023.101076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/09/2022] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Background People with sickle cell disease frequently use complementary and integrative therapies to cope with their pain, yet few studies have evaluated their effectiveness. The 3-arm, 3-site pragmatic Hybrid Effectiveness-implementation Trial of Guided Relaxation and Acupuncture for Chronic Sickle Cell Disease Pain (GRACE) has 3 priorities: (1) evaluate guided relaxation and acupuncture to improve pain control; (2) determine the most appropriate and effective treatment sequence for any given patient based on their unique characteristics; and (3) describe the processes and structures required to implement guided relaxation and acupuncture within health care systems. Methods Participants (N = 366) are being recruited and randomized 1:1:1 to one of 2 intervention groups or usual care. The acupuncture intervention group receives 10 sessions over approximately 5 weeks. The guided relaxation intervention group receives access to video sessions ranging from 2 to 20 min each viewed daily over 5 weeks. The usual care group receives the standard of clinical care for sickle cell disease. Participants are re-randomized at 6 weeks depending on their pain impact score. Assessments occur at 6 weeks, 12 weeks, and 24 weeks. The primary outcome is the change in pain impact score and secondary measures include opioid use, anxiety, depression, sleep, pain catastrophizing, substance use, global impression of change, constipation, and hospitalizations. The GRACE study uses the Consolidated Framework for Implementation Research to plan, execute, and evaluate the associated implementation processes. Conclusion The results from GRACE will represent a critical step toward improving management of pain affecting patients with sickle cell disease.ClinicalTrials.gov Identifier: NCT04906447.
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Affiliation(s)
- Ardith Z. Doorenbos
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Judith M. Schlaeger
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Victoria A. deMartelly
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Larisa A. Burke
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Andrew D. Boyd
- College of Applied Health Sciences, 1919 W Taylor St, Chicago, IL, 60612, USA
| | | | - Jonathan W. Leigh
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Hongjin Li
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Molly W. Mandernach
- Department of Medicine, UF Health, PO Box 100278, Gainesville, FL, 32610, USA
| | - Robert E. Molokie
- College of Applied Health Sciences, 1919 W Taylor St, Chicago, IL, 60612, USA
- Jesse Brown VA Medical Center, Chicago, IL, 60612, USA
| | - Crystal L. Patil
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Alana D. Steffen
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Nirmish Shah
- Department of Medicine, Duke University, 40 Medicine Circle, Durham, NC, 27710, USA
| | - Miriam O. Ezenwa
- College of Nursing, University of Florida, 1225 Center Drive, PO Box 100197, Gainesville, FL, 32610-0197, USA
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10
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Hays RD, Qureshi N, Edelen M, Rodriguez A, Slaughter M, Herman PM. Crosswalking the National Institutes of Health Impact Stratification Score to the PEG. Arch Phys Med Rehabil 2023; 104:425-429. [PMID: 36030893 PMCID: PMC9968815 DOI: 10.1016/j.apmr.2022.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To crosswalk the National Institutes of Health (NIH) Pain Consortium's Research Task Force proposed Impact Stratification Score (ISS) to the PEG (Pain Intensity, Interference With Enjoyment of Life, Interference With General Activity) Scale. DESIGN Cross-sectional data collected in 2021. Ordinary least squares regression analyses of ISS and PEG. SETTING Amazon Mechanical Turk workers. PARTICIPANTS 1931 adults with back pain with an average age of 41 (range, 19-77); 48% were female, 16% Hispanic, 7% non-Hispanic Black, 5% non-Hispanic Asian, and 71% non-Hispanic White (N=1931). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Patient-Reported Outcomes Measurement Information System (PROMIS)-29+2 v2.1 survey that includes the ISS, and the 3-item PEG. RESULTS The ISS and PEG had a correlation coefficient of 0.74. The ISS accounted for 55% of the adjusted variance in the PEG and the standardized average deviation between observed and predicted scores (normalized mean absolute error) was 0.53. Likewise, the PEG explained 55% of the variance in the ISS with a normalized mean absolute error of 0.52. CONCLUSIONS This study provides a crosswalk between the ISS and PEG that can be used to predict one from the other. The regression equations can facilitate comparisons in studies that use different measures.
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Affiliation(s)
- Ron D Hays
- UCLA Department of Medicine, Los Angeles, CA; Health Care Division, RAND Corporation, Santa Monica, CA.
| | - Nabeel Qureshi
- Health Care Division, RAND Corporation, Santa Monica, CA
| | - Maria Edelen
- Health Care Division, RAND Corporation, Santa Monica, CA; Patient Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Mary Slaughter
- Health Care Division, RAND Corporation, Santa Monica, CA
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11
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Akkarakittichoke N, Waongenngarm P, Janwantanakul P. Effects of Postural Shifting Frequency on Perceived Musculoskeletal Discomfort During 1-Hour Sitting in Office Workers. J Manipulative Physiol Ther 2023; 46:76-85. [PMID: 37777939 DOI: 10.1016/j.jmpt.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/22/2023] [Accepted: 06/26/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effects of postural shifting frequency on perceived musculoskeletal discomfort during 1 hour of sitting in healthy office workers. METHODS An experimental study comparing 3 different postural shifting frequencies was conducted on 60 healthy office workers who were asked to sit for an hour. The effects of 3 postural shifts (ie, 10, 20, and 30 times/h) on discomfort, measured by Borg's CR-10 scale, were compared. A seat pressure mat was used to confirm an individual's postural shift. RESULTS Postural shifting frequency of 10 to 30 times/h had significant effects on perceived discomfort in the neck, shoulder, and upper and lower back during 1-hour sitting. At the neck and shoulder, a postural shifting frequency of 30 times/h significantly reduced perceived discomfort compared to a postural shifting frequency of 10 times/h during 1-hour sitting. At the upper and lower back, a postural shifting frequency of 20 to 30 times/h significantly reduced perceived discomfort compared to a postural shifting frequency of 10 times/h. CONCLUSION Postural shifts of 30 times/h provided buffering effects on perceived musculoskeletal discomfort at the neck, shoulder, and upper and lower back.
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Affiliation(s)
- Nipaporn Akkarakittichoke
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Pooriput Waongenngarm
- Faculty of Health Science Technology, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Prawit Janwantanakul
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
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12
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The Canadian version of the National Institutes of Health minimum dataset for chronic low back pain research: reference values from the Quebec Low Back Pain Study. Pain 2023; 164:325-335. [PMID: 36638305 PMCID: PMC9833111 DOI: 10.1097/j.pain.0000000000002703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/23/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT The National Institutes of Health (NIH) minimum dataset for chronic low back pain (CLBP) was developed in response to the challenge of standardizing measurements across studies. Although reference values are critical in research on CLBP to identify individuals and communities at risk of poor outcomes such as disability, no reference values have been published for the Quebec (Canada) context. This study was aimed to (1) provide reference values for the Canadian version of the NIH minimum dataset among individuals with CLBP in Quebec, both overall and stratified by gender, age, and pain impact stratification (PIS) subgroups, and (2) assess the internal consistency of the minimum data set domains (pain interference, physical function, emotional distress or depression, sleep disturbance, and PIS score). We included 2847 individuals living with CLBP who completed the baseline web survey of the Quebec Low Back Pain Study (age: 44.0 ± 11.2 years, 48.1% women) and were recruited through social media and healthcare settings. The mean score was 6.1 ± 1.8 for pain intensity. Pain interference, physical function, emotional distress or depression, sleep disturbance, and PIS scores were 12.9 ± 4.1, 14.4 ± 3.9, 9.8 ± 4.4, 13.0 ± 3.6, and 26.4 ± 6.6, respectively. Emotional distress or depression showed floor effects. Good-to-excellent internal consistency was found overall and by language, gender, and age subgroups for all domains (alpha: 0.81-0.93) and poor-to-excellent internal consistency for PIS subgroups (alpha: 0.59-0.91). This study presents reference values and recommendations for using the Canadian version of the NIH minimum dataset for CLBP that can be useful for researchers and clinicians.
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13
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Guo YJ, Hu XY, Li JY, Yang L. Effects of a WeChat-based individualized post-discharge rehabilitation program on patients with lumbar fusion surgery. J Back Musculoskelet Rehabil 2022; 35:545-557. [PMID: 34744066 DOI: 10.3233/bmr-200280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Exercise training after lumbar fusion surgery (LFS) is important for regaining the strength in the spinal muscles, pain management, and minimizing dysfunction. It may be prudent to evaluate technologies such as web-based chat and social media apps for increasing the efficacy of post-surgery interventions in LFS patients. OBJECTIVE To explore the effectiveness of a WeChat-based individualized post-discharge rehabilitation program in patients with LFS. METHODS Seventy-two eligible discharged LFS patients were enrolled from October 2018 to February 2019. The experimental group (36 cases) received a 10-week WeChat-based individualized rehabilitation program, while the control group (36 cases) received routine follow-up guidance. The outcomes were measured using the Exercise Compliance Questionnaire, Numerical Rating Scale, Oswestry Disability Index and Chinese version of the self-efficacy for exercise scale. RESULTS The analysis using generalized estimation equations method shows significant differences in the interaction effect of group*time in exercise compliance (Wald c2= 7.459, P< 0.05), group effect in pain (Wald c2= 5.811, P< 0.05) and self-efficacy (Wald c2= 16.383, P< 0.05). However, there was no significant difference between the experimental and control groups in the group effect in dysfunction improvement (Wald c2= 2.289, P> 0.05). CONCLUSIONS The WeChat-based rehabilitation intervention can improve exercise compliance and self-efficacy, and help achieve greater pain relief compared to the routine intervention. However, the WeChat-based intervention did not offer better improvement in the self-dysfunction in the post-discharge LFS patients.
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Affiliation(s)
- Yu-Jie Guo
- School of Medicine (School of Nursing), Nantong University, Nantong, Jiangsu, China
| | - Xiao-Yun Hu
- School of Pharmacy , Nanjing Medical University, Nanjing, Jiangsu, China.,School of Medicine (School of Nursing), Nantong University, Nantong, Jiangsu, China
| | - Jia-Yu Li
- School of Health and Nursing Science, Nantong Institute of Technology, Nantong, Jiangsu, China.,School of Medicine (School of Nursing), Nantong University, Nantong, Jiangsu, China
| | - Lei Yang
- First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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14
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Ballester J, Baker AK, Martikainen IK, Koppelmans V, Zubieta JK, Love TM. Risk for opioid misuse in chronic pain patients is associated with endogenous opioid system dysregulation. Transl Psychiatry 2022; 12:20. [PMID: 35022382 PMCID: PMC8755811 DOI: 10.1038/s41398-021-01775-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/02/2021] [Accepted: 12/21/2021] [Indexed: 02/04/2023] Open
Abstract
µ-Opioid receptors (MOR) are a major target of endogenous and exogenous opioids, including opioid pain medications. The µ-opioid neurotransmitter system is heavily implicated in the pathophysiology of chronic pain and opioid use disorder and, as such, central measures of µ-opioid system functioning are increasingly being considered as putative biomarkers for risk to misuse opioids. To explore the relationship between MOR system function and risk for opioid misuse, 28 subjects with chronic nonspecific back pain completed a clinically validated measure of opioid misuse risk, the Pain Medication Questionnaire (PMQ), and were subsequently separated into high (PMQ > 21) and low (PMQ ≤ 21) opioid misuse risk groups. Chronic pain patients along with 15 control participants underwent two separate [11C]-carfentanil positron emission tomography scans to explore MOR functional measures: one at baseline and one during a sustained pain-stress challenge, with the difference between the two providing an indirect measure of stress-induced endogenous opioid release. We found that chronic pain participants at high risk for opioid misuse displayed higher baseline MOR availability within the right amygdala relative to those at low risk. By contrast, patients at low risk for opioid misuse showed less pain-induced activation of MOR-mediated, endogenous opioid neurotransmission in the nucleus accumbens. This study links human in vivo MOR system functional measures to the development of addictive disorders and provides novel evidence that MORs and µ-opioid system responsivity may underlie risk to misuse opioids among chronic pain patients.
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Affiliation(s)
- Javier Ballester
- grid.223827.e0000 0001 2193 0096Department of Psychiatry, University of Utah, Salt Lake City, UT USA ,grid.280807.50000 0000 9555 3716Mental Health Addiction Services, VA Salt Lake City Health Care System, Salt Lake City, UT USA
| | - Anne K. Baker
- grid.26009.3d0000 0004 1936 7961Department of Anesthesiology, Duke University, Durham, NC USA
| | - Ilkka K. Martikainen
- grid.412330.70000 0004 0628 2985Department of Radiology, Medical Imaging Center, Tampere University Hospital, Tampere, Finland
| | - Vincent Koppelmans
- grid.223827.e0000 0001 2193 0096Department of Psychiatry, University of Utah, Salt Lake City, UT USA
| | - Jon-Kar Zubieta
- grid.429302.e0000 0004 0427 6012Department of Psychiatry, Northwell Health, John T. Mather Memorial Hospital, Port Jefferson, NY USA
| | - Tiffany M. Love
- grid.223827.e0000 0001 2193 0096Department of Psychiatry, University of Utah, Salt Lake City, UT USA
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15
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Gao S, Zhou H, Luo S, Cai X, Ye F, He Q, Huang C, Zheng X, Li Y, Du Z, Wang Y, Qi Z, Wang Z. Investigating the Causal Relationship Between Physical Activity and Chronic Back Pain: A Bidirectional Two-Sample Mendelian Randomization Study. Front Genet 2021; 12:758639. [PMID: 34987546 PMCID: PMC8721110 DOI: 10.3389/fgene.2021.758639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/25/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Recent observational studies have reported a negative association between physical activity and chronic back pain (CBP), but the causality of the association remains unknown. We introduce bidirectional Mendelian randomization (MR) to assess potential causal inference between physical activity and CBP. Materials and Methods: This two-sample MR used independent genetic variants associated with physical activity and CBP as genetic instruments from large genome-wide association studies (GWASs). The effects of both directions (physical activity to CBP and CBP to physical activity) were examined. Inverse variance-weighted meta-analysis and alternate methods (weighted median and MR-Egger) were used to combine the MR estimates of the genetic instruments. Multiple sensitivity analyses were conducted to examine the robustness of the results. Results: The MR set parallel GWAS cohorts, among which, those involved in the primary analysis were comprised of 337,234 participants for physical activity and 158,025 participants (29,531 cases) for CBP. No evidence of a causal relationship was found in the direction of physical activity to CBP [odds ratio (OR), 0.98; 95% CI, 0.85-1.13; p = 0.81]. In contrast, a negative causal relationship in the direction of CBP to physical activity was detected (β = -0.07; 95% CI, -0.12 to -0.01; p = 0.02), implying a reduction in moderate-vigorous physical activity (approximately 146 MET-minutes/week) for participants with CBP relative to controls. Conclusion: The negative relationship between physical activity and CBP is probably derived from the reduced physical activity of patients experiencing CBP rather than the protective effect of physical activity on CBP.
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Affiliation(s)
- Shaowei Gao
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Huaqiang Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Siyu Luo
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Xiaoying Cai
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Fang Ye
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Qiulan He
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Chanyan Huang
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Xiaoyang Zheng
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Ying Li
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Zhanxin Du
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Yaqing Wang
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Zhihui Qi
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Zhongxing Wang
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
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16
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Barth J, Muff S, Kern A, Zieger A, Keiser S, Zoller M, Rosemann T, Brinkhaus B, Held L, Witt CM. Effect of Briefing on Acupuncture Treatment Outcome Expectations, Pain, and Adverse Side Effects Among Patients With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2121418. [PMID: 34505889 PMCID: PMC8433606 DOI: 10.1001/jamanetworkopen.2021.21418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE In observational studies, patients' treatment outcome expectations have been associated with better outcomes (ie, a placebo response), whereas concerns about adverse side effects have been associated with an in increase in the negative effects of treatments (ie, a nocebo response). Some randomized trials have suggested that communication from clinicians could affect the treatment outcomes by changing patients' expectations. OBJECTIVE To investigate whether treatment outcome expectations and reported adverse side effects could be affected by different briefing contents before a minimal acupuncture treatment in patients with chronic low back pain (CLBP). DESIGN, SETTING, AND PARTICIPANTS This randomized single-blinded clinical trial was conducted among patients with CLBP at 1 outpatient clinic in Switzerland who had a pain intensity of at least 4 on a numeric rating scale from 0 to 10. Different recruitment channels were used to enroll patients. Data were collected from May 2016 to December 2017 and were analyzed from June to November 2018. INTERVENTIONS Patients were randomized to receive either a regular expectation briefing or a high expectation briefing (effectiveness) and either a regular adverse side effect briefing or an intense adverse side effect briefing (adverse side effect) in a 2 × 2 factorial design. The intervention (briefing sessions and written materials) was standardized and delivered before the acupuncture treatment, with additional booster informative emails provided during the 4-week, 8-session acupuncture course. MAIN OUTCOMES AND MEASURES The primary end point was the patients' expectations regarding the effectiveness of the acupuncture treatment (Expectation for Treatment Scale [ETS]) after the briefing and the subsequent pain intensity (numeric rating scale). The primary end point for the adverse side effect briefing was the adverse side effect score at the end of the acupuncture treatment, derived from session-by-session assessments of adverse side effects. RESULTS A total of 152 patients with CLBP (mean [SD] age, 39.54 [12.52] years; 100 [65.8%] women) were included. The estimated group difference (regular vs high) for the ETS was -0.16 (95% CI -0.81 to 0.50, P = .64), indicating no evidence for a difference between intervention groups. There was also no evidence for a difference in pain intensity at the end of the acupuncture treatment between the groups with different expectation briefings. The adverse side effects score in the group with the intense adverse side effect briefing were estimated to be 1.31 times higher (95% CI, 0.94 to 1.82; P = .11) than after a regular adverse side effect briefing, but the finding was not statistically significant. CONCLUSIONS AND RELEVANCE In this study, suggestions regarding treatment benefits (placebo) and adverse side effects (nocebo) did not affect treatment expectations or adverse side effects. Information regarding adverse side effects might require more research to understand nocebo responses. TRIAL REGISTRATION German Clinical Trials Register Identifier: DRKS00010191.
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Affiliation(s)
- Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stefanie Muff
- Department of Biostatistics at the Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alexandra Kern
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Anja Zieger
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stefanie Keiser
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Marco Zoller
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, Zurich, Switzerland
| | - Benno Brinkhaus
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Leonhard Held
- Department of Biostatistics at the Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Claudia M. Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
- Center for Integrative Medicine, University of Maryland, School of Medicine, Baltimore
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17
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Low Back Pain Flares: How do They Differ From an Increase in Pain? Clin J Pain 2021; 37:313-320. [PMID: 33830090 DOI: 10.1097/ajp.0000000000000926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The term flare is commonly used to describe low back pain (LBP) fluctuations, but individuals with LBP consider that it does not always correspond to increased pain. This case cross-over study aimed to: (1) determine the extent to which days with a flare identified according to a multidimensional definition (self-reported flare, SRF) corresponded to days with greater than average pain (pain-defined flare, PDF) and (2) to investigate whether physical and psychosocial features differ between PDF and SRF. MATERIALS AND METHODS Individuals with LBP for ≥3 months (N=126) provided data on flares, physical, and psychosocial features daily for 28 days using a smartphone application. RESULTS Most days with SRF (68%) did not have greater than average pain (ie, PDF), but most days with greater than average pain (64%) were reported as an SRF. On days with SRF-only all physical and psychosocial features were worse than nonflare days. SRF+PDF had lower sleep quality and higher pain intensity, fatigue, disability, pain catastrophizing, and fear avoidance than SRF-only. SRF+PDF had higher pain in the afternoon and evening, disability and pain catastrophizing than PDF-only. Self-efficacy at work and during leisure activities was worse on SRF+PDF days than SRF-only and PDF-only days. DISCUSSION These findings highlight that when individuals with LBP consider they have a flare, they do not always have greater than average pain, but have worse psychosocial features. This emphasizes that flare has broader dimensions than pain alone. Consideration of flare according to broad dimensions is important when investigating symptom fluctuations across different LBP trajectories.
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18
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Birckhead B, Eberlein S, Alvarez G, Gale R, Dupuy T, Makaroff K, Fuller G, Liu X, Yu KS, Black JT, Ishimori M, Venuturupalli S, Tu J, Norris T, Tighiouart M, Ross L, McKelvey K, Vrahas M, Danovitch I, Spiegel B. Home-based virtual reality for chronic pain: protocol for an NIH-supported randomised-controlled trial. BMJ Open 2021; 11:e050545. [PMID: 34130965 PMCID: PMC8207994 DOI: 10.1136/bmjopen-2021-050545] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Chronic pain is highly prevalent and associated with a large burden of illness; there is a pressing need for safe, home-based, non-pharmacological, interventions. Virtual reality (VR) is a digital therapeutic known to be effective for acute pain, but its role in chronic pain is not yet fully elucidated. Here we present a protocol for the National Institute of Health (NIH) Back Pain Consortium (BACPAC) VR trial that evaluates the effectiveness of three forms of VR for patients with chronic lower back pain (cLBP), a highly prevalent form of chronic pain. METHODS AND ANALYSIS The NIH BACPAC VR trial will randomise 360 patients with cLBP into one of three arms, each administered through a head-mounted display: 1) skills-based VR, a program incorporating principles of cognitive behavioural therapy, mindful meditation and physiological biofeedback therapy using embedded biometric sensors; 2) distraction-based VR, a program using 360-degree immersive videos designed to distract users from pain; and 3) sham VR, a non-immersive program using two-dimensional videos within a VR headset. Research participants will be monitored for 12 weeks using a combination of patient-reported outcomes administered via REDCap (Research Electronic Data Capture), wearable sensor data collected via Fitbit Charge 4 and electronic health record data. The primary outcome will be the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference scale. Secondary outcomes will include PROMIS Anxiety, PROMIS Sleep Disturbance, opioid prescription data and Pain Catastrophizing Scale Short Form. A subgroup analysis will explore patient level predictors for VR efficacy. ETHICS AND DISSEMINATION Ethics approval was obtained from the Institutional Review Board of Cedars-Sinai Health System in April 2020. The results will be disseminated in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04409353.
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Affiliation(s)
- Brandon Birckhead
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sam Eberlein
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Genie Alvarez
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rebecca Gale
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Taylor Dupuy
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Katherine Makaroff
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Garth Fuller
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Xiaoyu Liu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kyung-Sang Yu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Biomedical Sciences, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - J T Black
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mariko Ishimori
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Swamy Venuturupalli
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joseph Tu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tom Norris
- American Chronic Pain Association, Rocklin, California, USA
| | - Mourad Tighiouart
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lindsey Ross
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Karma McKelvey
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mark Vrahas
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brennan Spiegel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Li H, Patil CL, Molokie RE, Njoku F, Steffen AD, Doorenbos AZ, Schlaeger JM. Acupuncture for chronic pain in adults with sickle cell disease: a mixed-methods pilot study. Acupunct Med 2021; 39:612-618. [PMID: 34080441 PMCID: PMC8530874 DOI: 10.1177/09645284211017303] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Chronic pain is a common symptom experienced among patients with sickle cell disease (SCD). Our aims were to assess the feasibility and acceptability of performing acupuncture for the treatment of chronic pain in adults with SCD. METHODS This was a single-arm, prospective pilot study of six adults with SCD. Participants reported ⩾ 3 months of chronic pain and were > 18 years of age. Per protocol, acupuncture was to be administered twice per week for 5 weeks, for 30 min per session. All treatments were performed in the acupuncture treatment laboratory at the University of Illinois Chicago College of Nursing. Pain intensity, pain interference, and other symptoms were measured at baseline and after the intervention. Participants completed a semi-structured interview and a protocol acceptability questionnaire after the acupuncture intervention. RESULTS Six participants (mean age 52.5 years, six Black) were enrolled. Although the study was suspended due to COVID-19 and not all participants completed the 10-session protocol, completion rates were high with no missed appointments. One participant did not complete the study due to hospitalization unrelated to acupuncture. No adverse events were reported. At completion of the intervention at 4-5 weeks post-baseline, all participants had reduced pain intensity and pain interference. The mean acceptability score on the protocol acceptability questionnaire was 82%. CONCLUSION It was feasible and acceptable to implement acupuncture in adults with SCD. This study can be used to guide a larger randomized controlled trial to evaluate the effect of acupuncture on reducing chronic pain in adults with SCD.Trial registration number: NCT04156399 (ClinicalTrials.gov).
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Affiliation(s)
- Hongjin Li
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Crystal L Patil
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Robert E Molokie
- Department of Hematology/Oncology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA.,Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA.,Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Franklin Njoku
- Department of Hematology/Oncology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Alana D Steffen
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Ardith Z Doorenbos
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Judith M Schlaeger
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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Hays RD, Orlando Edelen M, Rodriguez A, Herman P. Support for the Reliability and Validity of the National Institutes of Health Impact Stratification Score in a Sample of Active-Duty U.S. Military Personnel with Low Back Pain. PAIN MEDICINE 2021; 22:2185-2190. [PMID: 34022052 DOI: 10.1093/pm/pnab175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Evaluate the Impact Stratification Score (ISS) measure of low back pain impact that assesses physical function, pain interference, and pain intensity. DESIGN Secondary analyses of a prospective comparative effectiveness trial of active-duty military personnel with low back pain. SETTING A Naval hospital at a military training site (Pensacola, Florida) and two military medical centers: 1) Walter Reed National Military Medical Center (Bethesda, Maryland); and 2) San Diego Naval Medical Center. SUBJECTS The 749 active-duty military personnel had an average age of 31, 76% were male and 67% white. METHODS Participants completed questionnaires at baseline, 6-weeks later, and 12-weeks later. Measures included the ISS, Roland-Morris Disability Questionnaire (RMDQ), PROMIS-29 v1.0 satisfaction with social role participation scale, and single-item ratings of average pain, feeling bothered by low back pain in the past week, and a rating of change in low back pain. RESULTS Internal consistency reliability for the ISS was 0.92-0.93 at the three time points. The ISS correlated 0.75 to 0.84 with the RMDQ, 0.51 to 0.78 with the single-item ratings, and -0.64 to -0.71 with satisfaction with social role participation. The ISS was responsive to change on the three single items. The area under the curve for the ISS predicting improvement on the rating of change from baseline to 6-weeks later was 0.83. CONCLUSIONS This study provides support for the reliability and validity of the ISS as a patient-reported summary measure for acute, subacute, and chronic low back pain. The ISS is a useful indicator of low back impact.
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Affiliation(s)
- Ron D Hays
- Division of General Internal Medicine & Health Services Research, UCLA Department of Medicine, Los Angeles, CA
| | - Maria Orlando Edelen
- RAND Corporation, Boston, MA.,Patient Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, MA
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21
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van der Molen HF, Visser S, Alfonso JH, Curti S, Mattioli S, Rempel D, Roquelaure Y, Kuijer PPFM, Tamminga SJ. Diagnostic criteria for musculoskeletal disorders for use in occupational healthcare or research: a scoping review of consensus- and synthesised-based case definitions. BMC Musculoskelet Disord 2021; 22:169. [PMID: 33573616 PMCID: PMC7879660 DOI: 10.1186/s12891-021-04031-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/28/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of this study was to identify case definitions of diagnostic criteria for specific musculoskeletal disorders (MSDs) for use in occupational healthcare, surveillance or research. METHODS A scoping review was performed in Medline and Web of Science from 2000 to 2020 by an international team of researchers and clinicians, using the Arksey and O'Malley framework to identify case definitions based on expert consensus or a synthesis of the literature. Seven MSDs were considered: non-specific low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral or medial elbow tendinopathy, and knee and hip osteoarthritis (OA). Case definitions for occupational healthcare or research were charted according to symptoms, signs and instrumental assessment of signs, and if reported, on work-related exposure criteria. RESULTS In total, 2404 studies were identified of which 39 were included. Fifteen studies (38%) reported on non-specific LBP, followed by knee OA (n = 8;21%) and CTS (n = 8;21%). For non-specific LBP, studies agreed in general on which symptoms (i.e., pain in lower back) and signs (i.e., absence of red flags) constituted a case definition while for the other MSDs considerable heterogeneity was found. Only two studies (5%), describing case definitions for LBP, CTS, and SAPS and lateral and medial elbow tendinopathy respectively, included work-related exposure criteria in their clinical assessment. CONCLUSION We found that studies on non-specific LBP agreed in general on which symptoms and signs constitute a case definition, while considerable heterogeneity was found for the other MSDs. For prevention of work-related MSDs, these MSD case definitions should preferably include work-related exposure criteria.
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Affiliation(s)
- Henk F van der Molen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Steven Visser
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jose Hernán Alfonso
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - David Rempel
- Division of Occupational and Environmental Medicine, University of California, San Francisco, USA
| | - Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, F-49000, Angers, France
| | - P Paul F M Kuijer
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sietske J Tamminga
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
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22
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Lansing JE, Ellingson LD, DeShaw KJ, Cruz-Maldonado G, Hurt TR, Meyer JD. A qualitative analysis of barriers and facilitators to reducing sedentary time in adults with chronic low back pain. BMC Public Health 2021; 21:215. [PMID: 33499812 PMCID: PMC7836448 DOI: 10.1186/s12889-021-10238-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/14/2021] [Indexed: 02/08/2023] Open
Abstract
Background Sedentary time (SED) is associated with many detrimental health outcomes, yet little is known about what factors influence one’s ability to reduce SED. Even less is known about these factors in specific patient populations for whom high levels of SED may influence symptoms, such as those with chronic low back pain (cLBP). The purpose of this study was to qualitatively explore participants’ perceptions of factors that influenced their ability to reduce SED across an 8-week intervention to reduce SED in adults with cLBP and elevated depressive symptoms. Methods Three months after a theory-based intervention to break up and reduce sitting, semi-structured interviews explored factors that influenced reducing SED. Three researchers independently coded each conversation. Codes were charted and mapped with participants reviewing their own transcripts and the merged codes. The research team then defined key themes. Factors that were perceived to either facilitate behavior change or acted as barriers were identified and thematized as positive or negative determinants. Results Common barriers for reducing SED included environmental constraints, opposing social norms, and productivity; these barriers were frequently encountered in the workplace. Common facilitators for reducing SED included habit development, self-monitoring tools, restructuring the physical environment, and social accountability. Notably, back pain was not a frequently reported barrier or facilitator for reducing SED. Conclusion This sample of patients with cLBP and elevated depressive symptoms had similar determinants for reducing SED as previously reported in non-patient populations and did not appear to need strategies specific to dealing with chronic pain. Since work-related social norms and environmental factors were perceived as significant barriers to sitting less, workplace interventions that provide standing desks, offer standing meetings rooms, and/or institution-wide standing breaks may help reduce SED at work. The use of an activity monitor with sitting reminders and education regarding how to use the reminders as external cues to develop new sitting habits may also aid in adoption and adherence to this behavior change across settings. Developing coping plans and restructuring physical environments were perceived as successful strategies for overcoming social and environmental barriers. Future interventions targeting SED reductions may benefit from incorporating these strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10238-5.
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Affiliation(s)
- Jeni E Lansing
- Department of Kinesiology, Iowa State University, Ames, IA, USA.
| | - Laura D Ellingson
- Division of Health and Exercise Science, Western Oregon University, Monmouth, OR, USA
| | | | | | - Tera R Hurt
- Department of Human Development and Family Studies, Iowa State University, Ames, IA, USA
| | - Jacob D Meyer
- Department of Kinesiology, Iowa State University, Ames, IA, USA
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Waongenngarm P, van der Beek AJ, Akkarakittichoke N, Janwantanakul P. Perceived musculoskeletal discomfort and its association with postural shifts during 4-h prolonged sitting in office workers. APPLIED ERGONOMICS 2020; 89:103225. [PMID: 32755740 DOI: 10.1016/j.apergo.2020.103225] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
This study examined the characteristics of perceived discomfort and postural shifts at different magnitudes during a 4-h sitting period and the association between perceived discomfort and number of postural shifts. Forty healthy participants continuously typed a standardized text passage at a computer work station for 4 h. Subjects rated perceived body discomfort using Borg's CR-10 scale in 10 body regions (i.e. neck, shoulder, elbow, wrist/hand, upper back, lower back, buttock, thigh, knee, and ankle/foot). A seat pressure mat device was used to gather seat pressure data during sitting. Postural shifts were determined by analysis of the dispersion index of both ischial tuberosities from seat pressure data. The threshold for a postural shift was set at ±10% and ±20%. Perceived discomfort in all body regions increased continuously during a 4-h sitting period. The body regions with the highest perceived discomfort were the low back, buttocks, upper back, thigh, and neck. The average (±SD) numbers of postural shifts during the 1st, 2nd, 3rd, and 4th hour of sitting were 14.8 ± 9.5, 17.8 ± 9.4, 18.2 ± 11.1, and 18.1 ± 9.8 shifts per hour for the 10% threshold, and were 4.8 ± 4.4, 6.0 ± 5.6, 7.4 ± 6.7, and 7.7 ± 6.6 shifts per hour for the 20% threshold, respectively. Prolonged sitting led to an increase in perceived musculoskeletal discomfort over time. The number of postural shifts at both magnitudes increased in the first 2 h of sitting and, in the second 2-h period of sitting, only the number of larger postural shifts (with 20% threshold) increased. The findings extend our understanding of sitting behaviors.
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Affiliation(s)
- Pooriput Waongenngarm
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.
| | - Nipaporn Akkarakittichoke
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Prawit Janwantanakul
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
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de Lira MR, de Oliveira AS, França RA, Pereira AC, Godfrey EL, Chaves TC. The Brazilian Portuguese version of the Exercise Adherence Rating Scale (EARS-Br) showed acceptable reliability, validity and responsiveness in chronic low back pain. BMC Musculoskelet Disord 2020; 21:294. [PMID: 32398068 PMCID: PMC7218635 DOI: 10.1186/s12891-020-03308-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study aimed to adapt the Exercise Adherence Rating Scale (EARS) into Brazilian Portuguese and evaluate its measurement properties, given as reliability, validity, and responsiveness in patients with non-specific Chronic Low Back Pain (CLBP). METHODS A total of 108 patients with a mean age of 46.62 years (SD = 9.98) and CLBP participated in this longitudinal study. Participants were oriented on undertaking the prescribed exercises in the first session, and adherence behavior was assessed after 1 week, and finally reassessed after 2 weeks (test-retest reliability). Three weeks after the first assessment, they were invited again to full fill the EARS (responsiveness). The intraclass correlation coefficient (ICC2,1) and Cronbach's α were used to assess test-retest reliability and internal consistency, respectively. Spearman's correlation and confirmatory factor analysis (CFA) were used to assess construct validity, and the Receiver operating characteristic curve and area under the curve (AUC) were used to analyze responsiveness. RESULTS The one-factor EARS-Br (adherence behavior) structure with 6 items showed acceptable fit indexes (comparative fit index and goodness of fit index> 0.90 and root-mean-square error of approximation< 0.08). The EARS-Br scale showed acceptable internal consistency (α = 0.88) and excellent reliability (ICC = 0.91 [95% CI 0.86-0.94]). Mild to moderate correlations were observed between EARS-Br total score vs. disability, pain catastrophizing, depression/anxiety, fear-avoidance and pain intensity. A Minimally Important Change (MIC) of 5.5 in the EARS-Br total score was considered as a meaningful change in the adherence behavior (AUC = 0.82). Moderate accuracy (AUC = 0.89) was obtained for a 17/24 total EARS cutoff score after home exercise was prescribed. The sensitivity and specificity were also acceptable (greater than 80%). CONCLUSION Our results demonstrated acceptable EARS-Br reliability, validity, and responsiveness for patients with CLBP. A final score of 17/24 on EARS after the prescription of home-exercise could be used as a cut-off for an acceptable adherence behavior associated with improvement in patient outcomes.
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Affiliation(s)
- Mariana Romano de Lira
- Post Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Anamaria Siriani de Oliveira
- Department of Health Sciences and Post Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Roberta Aniceto França
- Physical Therapy undergraduate course from Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana Claudia Pereira
- Physical Therapy undergraduate course from Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Emma L Godfrey
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King's College London, 2nd Floor Addison House, Guy's Campus, London, SE1 1UL, UK
- Department of Psychology, IoPPN, King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London, SE1 9RT, UK
| | - Thais Cristina Chaves
- Department of Health Sciences and Post Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Beyera GK, O'Brien J, Campbell S. Determinants of healthcare utilisation for low back pain: A population-based study in Ethiopia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1058-1070. [PMID: 31894620 DOI: 10.1111/hsc.12939] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/19/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
Low back pain (LBP) remains one of the major public health problems worldwide. However, in low-income countries, such as those in Africa, the epidemiological data on healthcare utilisation for LBP are lacking due to more pressing problems such as infectious diseases, to which the majority of health resources are channelled. Therefore, this study aimed at investigating the determinants of healthcare utilisation for LBP in the general population of Ethiopia. A population-based cross-sectional study was conducted in South-West Shewa zone of Ethiopia from June to November 2018. The data were collected by interviewing adults with LBP (n = 1812, randomly selected) using a psychometrically tested and validated instrument, analysed using R version 3.5.1. A log-binomial regression model was used to determine the prevalence ratio with a 95% confidence interval (CI) in identifying factors associated with healthcare utilisation for LBP. Estimates of population parameters were also presented with 95% CIs and p values. For all applications of inferential statistics, a p value of ≤.05 was taken as the significance level. The lifetime prevalence of healthcare utilisation for LBP was 36.1%, 95% CI: 33.9-38.1, while the annual prevalence rate was 30%, 95% CI: 27.9-32.2. Of those with a 1-year history of healthcare utilisation, while 7.4%, 95% CI: 4.9-10.3 rural and 36.6%, 95% CI: 29.5-44 urban populations utilised healthcare from general hospitals, 1.4%, 95% CI: 0.3-2.7 rural and 6.8%, 95% CI: 3.1-10.8 urban populations utilised healthcare from specialised hospitals. Several sociodemographic factors, modifiable health behaviours/lifestyle habits, pain interrelated factors, and specific factors such as beliefs about the pain, depressive symptoms and insomnia were associated with healthcare utilisation for LBP. The implications of this research are that it may be prudent for the Ethiopian healthcare policy makers to develop the necessary strategies to meet the health needs of both urban and rural populations with LBP.
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Affiliation(s)
- Getahun K Beyera
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jane O'Brien
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Steven Campbell
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
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Butowicz CM, Silfies SP, Vendemia J, Farrokhi S, Hendershot BD. Characterizing and Understanding the Low Back Pain Experience Among Persons with Lower Limb Loss. PAIN MEDICINE 2019; 21:1068-1077. [DOI: 10.1093/pm/pnz293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Objective
This study preliminarily characterizes and compares the impact of lower limb loss and development of chronic low back pain (cLBP) on psychosocial factors, as well as the relationship between these factors and low back pain–related functional disability.
Design
Cross-sectional study.
Methods
Participants were adults, active duty or retired military, with traumatic lower limb loss with and without chronic low back pain. Psychosocial factors and low back pain–related functional disability were measured using common clinical self-report questionnaires. The presence of psychosocial factors was compared between those with and without cLBP using multivariate analysis of covariance (P < 0.05), and correlations determined relationships between psychosocial factors and cLBP-related functional disability.
Results
There were no statistically significant differences among psychosocial factors between those with vs without cLBP (F(4, 13) = 0.81, P = 0.54, η2= 0.19). Employment status (ρ = 0.43, P = 0.02), anxiety (ρ = 0.45, P = 0.04), and kinesiophobia (ρ = 0.47, P = 0.04) were moderately associated with low back pain–related disability.
Conclusions
Psychological (i.e., anxiety) and social (i.e., employment status) factors may influence how persons with traumatic lower limb loss respond to self-reported measures of low back pain–related disability. The findings suggest that the Modified Oswestry Disability Index identifies cLBP-related functional disability in the context of lower limb loss. These results support the interdependence among biological, psychological, and social factors, which should be collectively considered during the development of rehabilitative strategies to treat secondary musculoskeletal conditions within this population.
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Affiliation(s)
- Courtney M Butowicz
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
- Henry M. Jackson Foundation, for the Advancement of Military Medicine, Bethesda, Maryland
- Departments of Exercise Science
| | | | | | - Shawn Farrokhi
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, Maryland
- Naval Medical Center San Diego, San Diego, California
| | - Brad D Hendershot
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, Maryland
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To analyze responsiveness and minimal clinically important change (MCIC) of the US National Institutes of Health (NIH) minimal dataset for chronic low back pain (CLBP). SUMMARY OF BACKGROUND DATA The NIH minimal dataset is a 40-item questionnaire developed to increase use of standardized definitions and measures for CLBP. Longitudinal validity of the total minimal dataset and the subscale Impact Stratification are unknown. METHODS Total outcome scores on the NIH minimal dataset, Dutch Language Version, were calculated ranging from 0 to 100 points with higher scores representing worse functioning. Responsiveness and MCIC were determined with an anchor-based method, calculating the area under the receiver operating characteristics (ROC) curve (AUC) and by determining the optimal cut-off point. Smallest detectable change (SDC) was calculated as a parameter of measurement error. RESULTS In total 223 patients with CLBP were included. Mean total score on the NIH minimal dataset was 44 ± 14 points at baseline. The total outcome score was responsive to change with an AUC of 0.84. MCIC was 14 points with a sensitivity of 72% and specificity 82%, and SDC was 23 points. Mean total score on Impact Stratification (scale 8-50) was 34.4 ± 7.4 points at baseline, with an AUC of 0.91, an MCIC of 7.5 with a sensitivity 96% of and specificity of 78%, and an SDC of 14 points. CONCLUSION The longitudinal validity of the NIH minimal dataset is adequate. An improvement of 14 points in total outcome score and 7.5 points in Impact Stratification can be interpreted as clinically important in individual patients. However, MCIC depends on baseline values and the method that is chosen to determine the optimal cut-off point. Furthermore, measurement error is larger than the MCIC. This means that individual change scores should be interpreted with caution. LEVEL OF EVIDENCE 2.
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Chronic low back pain influences trunk neuromuscular control during unstable sitting among persons with lower-limb loss. Gait Posture 2019; 74:236-241. [PMID: 31563825 DOI: 10.1016/j.gaitpost.2019.09.019] [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: 05/03/2019] [Revised: 08/16/2019] [Accepted: 09/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Persons with unilateral lower-limb loss are at increased risk for developing chronic low back pain. Aberrant trunk and pelvis motor behavior secondary to lower-limb loss potentially alters trunk postural control and increases demands on the trunk musculature for stability. However, it is unclear whether trunk postural control is associated with the presence or chronicity of low back pain within this population. RESEARCH QUESTION Is there a potential role of impaired trunk postural control among persons with lower limb loss and chronic low back pain? METHODS Two groups of males with unilateral lower-limb loss (n = 18 with chronic low back pain; n = 13 without pain) performed an unstable sitting task. Trunk postural control was characterized using traditional and non-linear measures derived from center-of-pressure time series, as well as trunk kinematics and the ratio of lumbar to thoracic erector spinae muscle activations. RESULTS Traditional and non-linear center-of-pressure measures and trunk muscle activation ratios were similar between groups, while participants with chronic low back pain demonstrated greater trunk motion and reduced local dynamic stability. SIGNIFICANCE Our results suggest that persons with both lower-limb loss and chronic low back pain exhibit impaired trunk postural control compared to those with limb loss but without pain. Aberrant trunk motor behavior may be a response to altered functional requirements of walking with a prosthesis. An inability to adequately control the trunk could lead to spinal instability and pain in the presence of repetitive exposure to aberrant motor behavior of these proximal structures during everyday activities.
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Ziadni MS, Sturgeon JA, Bissell D, Guck A, Martin KJ, Scott W, Trost Z. Injustice Appraisal, but not Pain Catastrophizing, Mediates the Relationship Between Perceived Ethnic Discrimination and Depression and Disability in Low Back Pain. THE JOURNAL OF PAIN 2019; 21:582-592. [PMID: 31562992 DOI: 10.1016/j.jpain.2019.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/04/2019] [Accepted: 09/11/2019] [Indexed: 01/03/2023]
Abstract
Despite growing evidence of significant racial disparities in the experience and treatment of chronic pain, the mechanisms by which these disparities manifest have remained relatively understudied. The current study examined the relationship between past experiences of racial discrimination and pain-related outcomes (self-rated disability and depressive symptomatology) and tested the potential mediating roles of pain catastrophizing and perceived injustice related to pain. Analyses consisted of cross-sectional path modeling in a multiracial sample of 137 individuals with chronic low back pain (Hispanics: n = 43; blacks: n = 43; whites: n = 51). Results indicated a positive relationship between prior discriminatory experiences and severity of disability and depressive symptoms. In mediation analyses, pain-related appraisals of injustice, but not pain catastrophizing, were found to mediate these relationships. Notably, the association between discrimination history and perceived injustice was significantly stronger in black and Hispanic participants and was not statistically significant in white participants. The findings suggest that race-based discriminatory experiences may contribute to racial disparities in pain outcomes and highlight the specificity of pain-related, injustice-related appraisals as a mechanism by which these experiences may impair physical and psychosocial function. Future research is needed to investigate temporal and causal mechanisms suggested by the model through longitudinal and clinical intervention studies. PERSPECTIVE: More frequent prior experiences of racial discrimination are associated with greater depressive symptomatology and pain-related disability in individuals with chronic low back pain. These associations are explained by the degree of injustice perception related to pain, but not pain catastrophizing, and were stronger among black and Hispanic participants.
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Affiliation(s)
- Maisa S Ziadni
- Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California
| | - John A Sturgeon
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington.
| | - Daniel Bissell
- Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California
| | - Adam Guck
- Department of Family Medicine, John Peter Smith Health Network, Fort Worth, Texas
| | - Kelly J Martin
- Department of Psychology, University of North Texas, Denton, Texas
| | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Zina Trost
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
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Krock E, Millecamps M, Anderson KM, Srivastava A, Reihsen TE, Hari P, Sun YR, Jang SH, Wilcox GL, Belani KG, Beebe DS, Ouellet J, Pinto MR, Kehl LJ, Haglund L, Stone LS. Interleukin-8 as a therapeutic target for chronic low back pain: Upregulation in human cerebrospinal fluid and pre-clinical validation with chronic reparixin in the SPARC-null mouse model. EBioMedicine 2019; 43:487-500. [PMID: 31047862 PMCID: PMC6558025 DOI: 10.1016/j.ebiom.2019.04.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/22/2019] [Accepted: 04/17/2019] [Indexed: 12/18/2022] Open
Abstract
Background Low back pain (LBP) is the leading global cause of disability and is associated with intervertebral disc degeneration (DD) in some individuals. However, many adults have DD without LBP. Understanding why DD is painful in some and not others may unmask novel therapies for chronic LBP. The objectives of this study were to a) identify factors in human cerebrospinal fluid (CSF) associated with chronic LBP and b) examine their therapeutic utility in a proof-of-concept pre-clinical study. Methods Pain-free human subjects without DD, pain-free human subjects with DD, and patients with chronic LBP linked to DD were recruited and lumbar MRIs, pain and disability levels were obtained. CSF was collected and analyzed by multiplex cytokine assay. Interleukin-8 (IL-8) expression was confirmed by ELISA in CSF and in intervertebral discs. The SPARC-null mouse model of progressive, age-dependent DD and chronic LBP was used for pre-clinical validation. Male SPARC-null and control mice received systemic Reparixin, a CXCR1/2 (receptors for IL-8 and murine analogues) inhibitor, for 8 weeks. Behavioral signs of axial discomfort and radiating pain were assessed. Following completion of the study, discs were excised and cultured, and conditioned media was evaluated with a protein array. Findings IL-8 was elevated in CSF of chronic LBP patients with DD compared to pain-free subjects with or without DD. Chronic inhibition with reparixin alleviated low back pain behaviors and attenuated disc inflammation in SPARC-null mice. Interpretation These studies suggest that the IL-8 signaling pathway is a viable therapy for chronic LBP. Fund Supported by NIH, MMF, CIHR and FRQS.
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Affiliation(s)
- Emerson Krock
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 0G1, Canada; McGill Scoliosis and Spine Research Group, McGill University, Montreal, Quebec H3A 1G1, Canada; Faculty of Medicine, Department of Surgery, Orthopaedic Research Lab, McGill University, Montreal, Quebec H3A 1G1, Canada.
| | - Magali Millecamps
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 0G1, Canada; McGill Scoliosis and Spine Research Group, McGill University, Montreal, Quebec H3A 1G1, Canada; Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada.
| | - Kathleen M Anderson
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Akanksha Srivastava
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 0G1, Canada; Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada.
| | - Troy E Reihsen
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Pawan Hari
- Department of Epidemiology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Yue Ran Sun
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 0G1, Canada; Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada.
| | - Seon Ho Jang
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 0G1, Canada; Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada.
| | - George L Wilcox
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Kumar G Belani
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - David S Beebe
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Jean Ouellet
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 0G1, Canada; McGill Scoliosis and Spine Research Group, McGill University, Montreal, Quebec H3A 1G1, Canada; Faculty of Medicine, Department of Surgery, Orthopaedic Research Lab, McGill University, Montreal, Quebec H3A 1G1, Canada; Shriner's Hospital for Children, 1003 Decarie Blvd, Montreal, Quebec H4A 0A9, Canada
| | | | - Lois J Kehl
- Minnesota Head & Neck Pain Clinic, St. Paul, MN 55114, USA.
| | - Lisbet Haglund
- McGill Scoliosis and Spine Research Group, McGill University, Montreal, Quebec H3A 1G1, Canada; Faculty of Medicine, Department of Surgery, Orthopaedic Research Lab, McGill University, Montreal, Quebec H3A 1G1, Canada; Shriner's Hospital for Children, 1003 Decarie Blvd, Montreal, Quebec H4A 0A9, Canada.
| | - Laura S Stone
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 0G1, Canada; McGill Scoliosis and Spine Research Group, McGill University, Montreal, Quebec H3A 1G1, Canada; Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada; Faculty of Medicine, Anesthesia Research Unit, Montreal, Montreal, Quebec H3A 1G1, Canada; Faculty of Medicine, Department of Pharmacology and Therapeutics, Montreal, Quebec H3A 1G1, Canada.
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Verburg AC, van Dulmen SA, Kiers H, Nijhuis-van der Sanden MWG, van der Wees PJ. Development of a standard set of outcome measures for non-specific low back pain in Dutch primary care physiotherapy practices: a Delphi study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1550-1564. [PMID: 31004195 DOI: 10.1007/s00586-019-05962-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/22/2019] [Accepted: 03/24/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop a clinical standard set of outcome measures that are accepted for relevance and feasibility by stakeholders and useful for (a) interaction between patient and the professional, e.g. shared decision-making in goal-setting, monitoring and feedback based on outcomes, (b) internal quality improvement, and (c) external transparency in patients with non-specific low back pain (NSLBP) in primary care physical therapy. METHODS We used a consensus-driven modified RAND-UCLA Delphi method in seven steps with panellists (patients, representatives of patient and physiotherapy associations, researchers, policy makers, health insurers): (1) literature search, (2) first online survey, (3) patient interviews, (4) an experts meeting, (5) a consensus meeting, (6) second online survey, and (7) final approval of an advisory board. Steps 1-4 resulted in potential outcome measures. In the consensus meeting after discussion panellists voted for inclusion per measure. In the second online survey the final standard set was rated on relevance and feasibility on a 9-point Likert scale; when the median score was ≥ 7, the standard set was accepted and finally approved. RESULTS Thirteen draft outcome measures were rated and discussed, and finally, six outcome measures were accepted. The standard set includes the Quebec Back Pain Disability Scale, Oswestry Disability Index, Patient-Specific Functional Scale, Numeric Pain Rating Scale, Global Perceived Effect (GPE-DV), and the STarT Back Screening Tool (SBT). CONCLUSION This study presents a standard set of outcome measures for patients with NSLBP in primary care physiotherapy accepted for relevance and feasibility by stakeholders. The standard set is currently used in daily practice and tested on validity and reliability in a pilot study. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- A C Verburg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
| | - S A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - H Kiers
- Institute for Human Movement Studies, Utrecht University of Applied Sciences, Utrecht, The Netherlands
- Association for Quality in Physical Therapy (SKF), Zwolle, The Netherlands
| | - M W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - P J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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Validation of the Dutch-Flemish PROMIS Pain Interference Item Bank in Patients With Musculoskeletal Complaints. Spine (Phila Pa 1976) 2019; 44:411-419. [PMID: 30113536 DOI: 10.1097/brs.0000000000002847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE The aim of this study was to validate the Dutch-Flemish PROMIS Pain Interference item bank in patients with musculoskeletal complaints. SUMMARY OF BACKGROUND DATA PROMIS item banks have been developed and validated in the US. They need to be further validated in various patient populations and in different languages. METHODS One thousand six hundred seventy-seven patients answered the full item bank. A Graded Response Model (GRM) was used to study dimensionality with confirmatory factor analyses and by assessing local independency. Monotonicity was evaluated with Mokken scaling. An Item Response Theory (IRT) model was used to study item fit and to estimate slope and threshold parameters. Differential item functioning (DIF) for language, age, and gender was assessed using ordinal logistic regression analyses. DIF for language was evaluated by comparing our data with a similar US sample. Hypotheses concerning construct validity were tested by correlating item bank-scores with scores on several legacy instruments. RESULTS The GRM showed suboptimal evidence of unidimensionality in confirmatory factor analysis [Comparative Fit Index (CFI): 0.903, Tucker-Lewis Index (TLI): 0.897, Root Mean Square Error of Approximation (RMSEA): 0.144], and 99 item pairs with local dependence. A bifactor model showed good fit (CFI: 0.964, TLI: 0.961, RMSEA: 0.089), with a high Omega-H (0.97), a high explained common variance (ECV: 0.81), and no local dependence. Sufficient monotonicity was shown for all items (Mokken H(i): 0.367-0.686). The unidimensional IRT model showed good fit (only two items with S-X < 0.001), with slope parameters ranging from 1.00 to 4.27, and threshold parameters ranging from -1.77 to 3.66. None of the items showed DIF for age or gender. One item showed DIF for language. Correlations with legacy instruments were high (Pearson R: 0.53-0.75), supporting construct validity. CONCLUSION The high omega-H and the high ECV indicate that the item bank could be considered essentially unidimensional. The item bank showed good item fit, good coverage of the pain interference trait, and good construct validity. LEVEL OF EVIDENCE N/A.
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Haws BE, Khechen B, Bawa MS, Patel DV, Bawa HS, Bohl DD, Wiggins AB, Cardinal KL, Guntin JA, Singh K. The Patient-Reported Outcomes Measurement Information System in spine surgery: a systematic review. J Neurosurg Spine 2019; 30:405-413. [PMID: 30611150 DOI: 10.3171/2018.8.spine18608] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/27/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to provide a standardized measure of clinical outcomes that is valid and reliable across a variety of patient populations. PROMIS has exhibited strong correlations with many legacy patient-reported outcome (PRO) measures. However, it is unclear to what extent PROMIS has been used within the spine literature. In this context, the purpose of this systematic review was to provide a comprehensive overview of the PROMIS literature for spine-specific populations that can be used to inform clinicians and guide future work. Specifically, the authors aimed to 1) evaluate publication trends of PROMIS in the spine literature, 2) assess how studies have used PROMIS, and 3) determine the correlations of PROMIS domains with legacy PROs as reported for spine populations.METHODSStudies reporting PROMIS scores among spine populations were identified from PubMed/MEDLINE and a review of reference lists from obtained studies. Articles were excluded if they did not report original results, or if the study population was not evaluated or treated for spine-related complaints. Characteristics of each study and journal in which it was published were recorded. Correlation of PROMIS to legacy PROs was reported with 0.1 ≤ |r| < 0.3, 0.3 ≤ |r| < 0.5, and |r| ≥ 0.5 indicating weak, moderate, and strong correlations, respectively.RESULTSTwenty-one articles were included in this analysis. Twelve studies assessed the validity of PROMIS whereas 9 used PROMIS as an outcome measure. The first study discussing PROMIS in patients with spine disorders was published in 2012, whereas the majority were published in 2017. The most common PROMIS domain used was Pain Interference. Assessments of PROMIS validity were most frequently performed with the Neck Disability Index. PROMIS domains demonstrated moderate to strong correlations with the legacy PROs that were evaluated. Studies assessing the validity of PROMIS exhibited substantial variability in PROMIS domains and legacy PROs used for comparisons.CONCLUSIONSThere has been a recent increase in the use of PROMIS within the spine literature. However, only a minority of studies have incorporated PROMIS for its intended use as an outcomes measure. Overall, PROMIS has exhibited moderate to strong correlations with a majority of legacy PROs used in the spine literature. These results suggest that PROMIS can be effective in the assessment and tracking of PROs among spine populations.
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Carriere JS, Martel MO, Meints SM, Cornelius MC, Edwards RR. What do you expect? Catastrophizing mediates associations between expectancies and pain-facilitatory processes. Eur J Pain 2019; 23:800-811. [PMID: 30506913 DOI: 10.1002/ejp.1348] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pain expectancies are associated with altered pain sensitivity in individuals with chronic pain. However, little is known about the processes by which pain expectancies impact pain processing. This study assessed the association between pain expectancies and temporal summation (TS) of pain, and examined whether pain catastrophizing mediated this association. METHODS In this cross-sectional study, participants (437 chronic low back pain [CLBP] patients, 115 controls) completed self-report measures of pain intensity, pain expectancies and pain catastrophizing before undergoing psychophysical pain-testing procedures designed to assess mechanical TS of mechanical pain. Pearson's correlations examined the associations between study variables in CLBP patients and controls. Bootstrapping mediation analyses assessed the mediating role of pain catastrophizing on the association between pain expectancies and TS of pain. RESULTS Temporal summation of pain was significantly associated with pain expectancies (r = 0.113) and pain catastrophizing (r = 0.171) in CLBP patients. Results of mediation analyses revealed that pain catastrophizing mediated the relationship between pain expectancies and TS of pain in CLBP patients (ab = 0.309, 95% CI = 0.1222-0.5604), but not in healthy controls (ab = -0.125, 95% CI = -0.5864 to 0.0244). CONCLUSIONS The findings from this study suggest that compared to controls, CLBP patients show increased sensitivity to mechanical pain procedures and enhanced pain-facilitatory processing, proving further evidence for changes in central nervous system pain processing in CLBP patients. Our results also suggest that pain catastrophizing may be the mechanism by which pain expectancies are associated with TS of pain in CLBP patients. SIGNIFICANCE Individuals with chronic low back pain who expect higher levels of pain and catastrophize about their pain are more likely to experience altered pain sensitivity. Our results point to catastrophizing as a mechanism of action through which psychological factors may operate and lead to the development and maintenance of chronic low back pain.
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Affiliation(s)
- Junie S Carriere
- Department of Anesthesiology, Brigham and Women's Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Marc Olivier Martel
- Faculties of Dentistry and Medicine, McGill University, Montreal, Quebec, Canada
| | - Samantha M Meints
- Department of Anesthesiology, Brigham and Women's Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Marise C Cornelius
- Department of Anesthesiology, Brigham and Women's Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Robert R Edwards
- Department of Anesthesiology, Brigham and Women's Hospital Pain Management Center, Harvard Medical School, Chestnut Hill, Massachusetts
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Tan WK, Hassanpour S, Heagerty PJ, Rundell SD, Suri P, Huhdanpaa HT, James K, Carrell DS, Langlotz CP, Organ NL, Meier EN, Sherman KJ, Kallmes DF, Luetmer PH, Griffith B, Nerenz DR, Jarvik JG. Comparison of Natural Language Processing Rules-based and Machine-learning Systems to Identify Lumbar Spine Imaging Findings Related to Low Back Pain. Acad Radiol 2018; 25:1422-1432. [PMID: 29605561 DOI: 10.1016/j.acra.2018.03.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate a natural language processing (NLP) system built with open-source tools for identification of lumbar spine imaging findings related to low back pain on magnetic resonance and x-ray radiology reports from four health systems. MATERIALS AND METHODS We used a limited data set (de-identified except for dates) sampled from lumbar spine imaging reports of a prospectively assembled cohort of adults. From N = 178,333 reports, we randomly selected N = 871 to form a reference-standard dataset, consisting of N = 413 x-ray reports and N = 458 MR reports. Using standardized criteria, four spine experts annotated the presence of 26 findings, where 71 reports were annotated by all four experts and 800 were each annotated by two experts. We calculated inter-rater agreement and finding prevalence from annotated data. We randomly split the annotated data into development (80%) and testing (20%) sets. We developed an NLP system from both rule-based and machine-learned models. We validated the system using accuracy metrics such as sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). RESULTS The multirater annotated dataset achieved inter-rater agreement of Cohen's kappa > 0.60 (substantial agreement) for 25 of 26 findings, with finding prevalence ranging from 3% to 89%. In the testing sample, rule-based and machine-learned predictions both had comparable average specificity (0.97 and 0.95, respectively). The machine-learned approach had a higher average sensitivity (0.94, compared to 0.83 for rules-based), and a higher overall AUC (0.98, compared to 0.90 for rules-based). CONCLUSIONS Our NLP system performed well in identifying the 26 lumbar spine findings, as benchmarked by reference-standard annotation by medical experts. Machine-learned models provided substantial gains in model sensitivity with slight loss of specificity, and overall higher AUC.
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France CR, Thomas JS. Virtual immersive gaming to optimize recovery (VIGOR) in low back pain: A phase II randomized controlled trial. Contemp Clin Trials 2018; 69:83-91. [PMID: 29730393 PMCID: PMC5975386 DOI: 10.1016/j.cct.2018.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/01/2018] [Indexed: 10/17/2022]
Abstract
The virtual immersive gaming to optimize recovery (VIGOR) study is a randomized controlled trial of the effects of virtual reality games to encourage lumbar spine flexion among individuals with chronic low back pain and fear of movement. Whereas traditional graded activity or graded exposure therapies for chronic low back pain have high attrition and poor long-term efficacy, we believe that virtual reality games have distinct advantages that can enhance adherence and clinical outcomes. First, they are engaging and enjoyable activities that can distract from pain and fear of harm. In addition, because they gradually reinforce increases in lumbar spine flexion to achieve game objectives, continued engagement over time is expected to promote recovery through restoration of normal spinal motion. The study design includes two treatment groups which differ in the amount of lumbar flexion required to achieve the game objectives. All participants will play the games for nine weeks, and pre-treatment to 1-week post-treatment changes in pain and disability will serve as the co-primary clinical outcomes. In addition, changes in lumbar flexion and expectations of pain/harm will be examined as potential treatment outcome mediators. Maintenance of treatment outcomes will also be assessed for up to 48-weeks post-treatment. In brief, we hypothesize that the virtual reality games will reduce pain and disability by promoting spinal motion and allowing participants to develop an implicit understanding that they are capable of engaging in significant lumbar spine motion in their daily lives without a risk of injury to their back.
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Affiliation(s)
| | - James S Thomas
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, USA
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Efficacy of Auricular Acupressure for Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:6383649. [PMID: 28804504 PMCID: PMC5539928 DOI: 10.1155/2017/6383649] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/14/2017] [Accepted: 06/08/2017] [Indexed: 12/19/2022]
Abstract
Objectives To identify the efficacy of auricular acupressure on pain and disability for chronic LBP by systematic review. Methods A search of randomized controlled trials was conducted in four English medical electronic databases and three Chinese databases. Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form. Meta-analyses were performed using all time-points meta-analysis. Results A total of 7 trials met the inclusion criteria, of which 4 had the low risk of bias. The findings of this study showed that, for the immediate effect, auricular acupressure had large, significant effects in improving pain within 12 weeks. As for the follow-up effect, the pooled estimates also showed promising effect at 4-week follow-up after 4-week intervention (standardized mean difference = −1.13, 95% CI (−1.70, −0.56), P < 0.001). But, for the disability level, the therapeutic effect was not significant (mean difference = −1.99, 95% CI (−4.93, 0.95), P = 0.18). No serious adverse effects were recorded. Conclusions The encouraging evidence of this study indicates that it is recommended to provide auricular acupressure to patients with chronic low back pain. However, a more accurate estimate of the effect will require further rigorously designed large-scale RCTs on chronic LBP for improving pain and disability.
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Factor analyses for the Örebro Musculoskeletal Pain Questionnaire for working and nonworking patients with chronic low back pain. Spine J 2017; 17:603-609. [PMID: 27916683 DOI: 10.1016/j.spinee.2016.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 10/26/2016] [Accepted: 11/28/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) has good psychometric properties to predict return to work in patients with acute low back pain. Although it is used in patients with chronic back pain and nonworkers, there is no evidence on the factor structure of the ÖMPQ in these populations. This is deemed an important prerequisite for future prediction studies. PURPOSE This study aimed to analyze the factor structure of the ÖMPQ in working and nonworking patients with chronic back pain. STUDY DESIGN/SETTING This is a cross-sectional study in a university-based spine center. PATIENT SAMPLE The patient sample consists two cohorts of working and nonworking adult patients (>18 years) with specific and nonspecific chronic back pain. OUTCOME MEASURES The Örebro Musculoskeletal Pain Questionnaire. METHODS Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed in working (N=557) and nonworking (N=266) patients for three, four, five, and six factors identified in literature. A goodness of fit index was calculated by a chi-square. Root mean square error of approximation (RMSEA) was calculated, and the number of factors identified was based on RMSEA values <.05. A Tucker-Lewis index (TLI) and a normed fit index (NFI) >0.90 are considered to indicate acceptable fit. RESULTS In working patients, a five-factor solution had the best fit (RMSEA<0.05; NFI and TLI >0.90), but substantial adaptations should be made to get proper fit (removal of the work-related items). In nonworking patients, a four-factor analysis had the best fit (RMSEA<0.05). For both samples, items related to duration could not fit in the overall model. CONCLUSIONS Factor structure of the ÖMPQ was not confirmed in working and nonworking patients with chronic back pain. Substantial adaptations should be made to obtain a factor structure with acceptable fit.
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Piazzolla A, Solarino G, Bizzoca D, Montemurro V, Berjano P, Lamartina C, Martini C, Moretti B. Spinopelvic parameter changes and low back pain improvement due to femoral neck anteversion in patients with severe unilateral primary hip osteoarthritis undergoing total hip replacement. 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 2017; 27:125-134. [DOI: 10.1007/s00586-017-5033-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/07/2017] [Indexed: 01/25/2023]
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Lacasse A, Roy JS, Parent AJ, Noushi N, Odenigbo C, Pagé G, Beaudet N, Choinière M, Stone LS, Ware MA. The Canadian minimum dataset for chronic low back pain research: a cross-cultural adaptation of the National Institutes of Health Task Force Research Standards. CMAJ Open 2017; 5:E237-E248. [PMID: 28401140 PMCID: PMC5378521 DOI: 10.9778/cmajo.20160117] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To better standardize clinical and epidemiological studies about the prevalence, risk factors, prognosis, impact and treatment of chronic low back pain, a minimum data set was developed by the National Institutes of Health (NIH) Task Force on Research Standards for Chronic Low Back Pain. The aim of the present study was to develop a culturally adapted questionnaire that could be used for chronic low back pain research among French-speaking populations in Canada. METHODS The adaptation of the French Canadian version of the minimum data set was achieved according to guidelines for the cross-cultural adaptation of self-reported measures (double forward-backward translation, expert committee, pretest among 35 patients with pain in the low back region). Minor cultural adaptations were also incorporated into the English version by the expert committee (e.g., items about race/ethnicity, education level). RESULTS This cross-cultural adaptation provides an equivalent French-Canadian version of the minimal data set questionnaire and a culturally adapted English-Canadian version. Modifications made to the original NIH minimum data set were minimized to facilitate comparison between the Canadian and American versions. INTERPRETATION The present study is a first step toward the use of a culturally adapted instrument for phenotyping French- and English-speaking low back pain patients in Canada. Clinicians and researchers will recognize the importance of this standardized tool and are encouraged to incorporate it into future research studies on chronic low back pain.
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Affiliation(s)
- Anaïs Lacasse
- Département des sciences de la santé (Lacasse, Odenigbo), Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que.; Faculté de médecine (Roy), Université Laval/Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Institut de réadaptation en déficience physique de Québec, Québec, Que.; Quebec Pain Research Network (Parent, Beaudet), Sherbrooke, Que.; Faculty of Dentistry (Noushi, Stone), McGill University; Centre de recherche du Centre hospitalier de l'Université de Montréal (Pagé, Choinière), Montréal, Que.; Département d'anesthésiologie (Beaudet), Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que.; Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; The Alan Edwards Centre for Research on Pain (Stone), McGill University; The Alan Edwards Pain Management Unit (Ware), McGill University Health Centre, Montréal, Que
| | - Jean-Sébastien Roy
- Département des sciences de la santé (Lacasse, Odenigbo), Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que.; Faculté de médecine (Roy), Université Laval/Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Institut de réadaptation en déficience physique de Québec, Québec, Que.; Quebec Pain Research Network (Parent, Beaudet), Sherbrooke, Que.; Faculty of Dentistry (Noushi, Stone), McGill University; Centre de recherche du Centre hospitalier de l'Université de Montréal (Pagé, Choinière), Montréal, Que.; Département d'anesthésiologie (Beaudet), Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que.; Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; The Alan Edwards Centre for Research on Pain (Stone), McGill University; The Alan Edwards Pain Management Unit (Ware), McGill University Health Centre, Montréal, Que
| | - Alexandre J Parent
- Département des sciences de la santé (Lacasse, Odenigbo), Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que.; Faculté de médecine (Roy), Université Laval/Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Institut de réadaptation en déficience physique de Québec, Québec, Que.; Quebec Pain Research Network (Parent, Beaudet), Sherbrooke, Que.; Faculty of Dentistry (Noushi, Stone), McGill University; Centre de recherche du Centre hospitalier de l'Université de Montréal (Pagé, Choinière), Montréal, Que.; Département d'anesthésiologie (Beaudet), Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que.; Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; The Alan Edwards Centre for Research on Pain (Stone), McGill University; The Alan Edwards Pain Management Unit (Ware), McGill University Health Centre, Montréal, Que
| | - Nioushah Noushi
- Département des sciences de la santé (Lacasse, Odenigbo), Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que.; Faculté de médecine (Roy), Université Laval/Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Institut de réadaptation en déficience physique de Québec, Québec, Que.; Quebec Pain Research Network (Parent, Beaudet), Sherbrooke, Que.; Faculty of Dentistry (Noushi, Stone), McGill University; Centre de recherche du Centre hospitalier de l'Université de Montréal (Pagé, Choinière), Montréal, Que.; Département d'anesthésiologie (Beaudet), Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que.; Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; The Alan Edwards Centre for Research on Pain (Stone), McGill University; The Alan Edwards Pain Management Unit (Ware), McGill University Health Centre, Montréal, Que
| | - Chúk Odenigbo
- Département des sciences de la santé (Lacasse, Odenigbo), Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que.; Faculté de médecine (Roy), Université Laval/Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Institut de réadaptation en déficience physique de Québec, Québec, Que.; Quebec Pain Research Network (Parent, Beaudet), Sherbrooke, Que.; Faculty of Dentistry (Noushi, Stone), McGill University; Centre de recherche du Centre hospitalier de l'Université de Montréal (Pagé, Choinière), Montréal, Que.; Département d'anesthésiologie (Beaudet), Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que.; Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; The Alan Edwards Centre for Research on Pain (Stone), McGill University; The Alan Edwards Pain Management Unit (Ware), McGill University Health Centre, Montréal, Que
| | - Gabrielle Pagé
- Département des sciences de la santé (Lacasse, Odenigbo), Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que.; Faculté de médecine (Roy), Université Laval/Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Institut de réadaptation en déficience physique de Québec, Québec, Que.; Quebec Pain Research Network (Parent, Beaudet), Sherbrooke, Que.; Faculty of Dentistry (Noushi, Stone), McGill University; Centre de recherche du Centre hospitalier de l'Université de Montréal (Pagé, Choinière), Montréal, Que.; Département d'anesthésiologie (Beaudet), Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que.; Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; The Alan Edwards Centre for Research on Pain (Stone), McGill University; The Alan Edwards Pain Management Unit (Ware), McGill University Health Centre, Montréal, Que
| | - Nicolas Beaudet
- Département des sciences de la santé (Lacasse, Odenigbo), Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que.; Faculté de médecine (Roy), Université Laval/Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Institut de réadaptation en déficience physique de Québec, Québec, Que.; Quebec Pain Research Network (Parent, Beaudet), Sherbrooke, Que.; Faculty of Dentistry (Noushi, Stone), McGill University; Centre de recherche du Centre hospitalier de l'Université de Montréal (Pagé, Choinière), Montréal, Que.; Département d'anesthésiologie (Beaudet), Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que.; Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; The Alan Edwards Centre for Research on Pain (Stone), McGill University; The Alan Edwards Pain Management Unit (Ware), McGill University Health Centre, Montréal, Que
| | - Manon Choinière
- Département des sciences de la santé (Lacasse, Odenigbo), Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que.; Faculté de médecine (Roy), Université Laval/Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Institut de réadaptation en déficience physique de Québec, Québec, Que.; Quebec Pain Research Network (Parent, Beaudet), Sherbrooke, Que.; Faculty of Dentistry (Noushi, Stone), McGill University; Centre de recherche du Centre hospitalier de l'Université de Montréal (Pagé, Choinière), Montréal, Que.; Département d'anesthésiologie (Beaudet), Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que.; Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; The Alan Edwards Centre for Research on Pain (Stone), McGill University; The Alan Edwards Pain Management Unit (Ware), McGill University Health Centre, Montréal, Que
| | - Laura S Stone
- Département des sciences de la santé (Lacasse, Odenigbo), Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que.; Faculté de médecine (Roy), Université Laval/Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Institut de réadaptation en déficience physique de Québec, Québec, Que.; Quebec Pain Research Network (Parent, Beaudet), Sherbrooke, Que.; Faculty of Dentistry (Noushi, Stone), McGill University; Centre de recherche du Centre hospitalier de l'Université de Montréal (Pagé, Choinière), Montréal, Que.; Département d'anesthésiologie (Beaudet), Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que.; Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; The Alan Edwards Centre for Research on Pain (Stone), McGill University; The Alan Edwards Pain Management Unit (Ware), McGill University Health Centre, Montréal, Que
| | - Mark A Ware
- Département des sciences de la santé (Lacasse, Odenigbo), Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que.; Faculté de médecine (Roy), Université Laval/Centre interdisciplinaire de recherche en réadaptation et en intégration sociale, Institut de réadaptation en déficience physique de Québec, Québec, Que.; Quebec Pain Research Network (Parent, Beaudet), Sherbrooke, Que.; Faculty of Dentistry (Noushi, Stone), McGill University; Centre de recherche du Centre hospitalier de l'Université de Montréal (Pagé, Choinière), Montréal, Que.; Département d'anesthésiologie (Beaudet), Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que.; Département d'anesthésiologie (Choinière), Faculté de médecine, Université de Montréal; The Alan Edwards Centre for Research on Pain (Stone), McGill University; The Alan Edwards Pain Management Unit (Ware), McGill University Health Centre, Montréal, Que
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Della Mora LS, Perruccio AV, Badley EM, Rampersaud YR. Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation. BMJ Open 2016; 6:e013060. [PMID: 27927661 PMCID: PMC5168682 DOI: 10.1136/bmjopen-2016-013060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To characterise and compare a persistent low back pain (LBP) population based on 4 clinical pain patterns. DESIGN Cross-sectional analysis of patient-reported data. SETTING Patients from 220 primary care practitioners in 3 cities in Ontario, Canada. PARTICIPANTS 1020 individuals seeking LBP care. INCLUSION CRITERIA LBP symptoms lasting 1½-12 months, or unmanageable recurrent symptoms; ages 18+years. EXCLUSION CRITERIA pregnant/1-year postpartum; involved in active litigation or motor vehicle injury; emergent spinal presentations; pain disorder diagnosis; work injury claim; or constant symptoms persisting >12 months postonset. MAIN OUTCOME MEASURE Hall pain pattern subgroups: back dominant pain aggravated by flexion (P1) or extension (P2), or leg dominant constant (P3) or intermittent (P4) pain (multinomial logistic outcome; referent: P1). RESULTS Groups P1 and P2 had the highest proportion of women. P2 and P4 had higher mean ages and comorbidity counts. P3 and P4 had higher proportions of overweight/obese individuals and lower general health scores. Adjusted models: being male and overweight/obese was associated with increased odds of being in P3 (OR 1.64 (95% CI 1.10 to 2.46), and OR 1.74 (1.13 to 2.68), respectively) and P4 (OR 1.87 (1.11 to 3.15) and OR 1.91 (1.06 to 3.42), respectively), and increasing age with increased odds of being in P2 (OR 1.02 (1.01 to 1.03)) and P4 (OR 1.06 (1.04 to 1.08)). Increasing comorbidity count was associated with increased odds of being in P2 (OR 1.14 (1.0 to 1.3)), and better general health scores with decreased odds of being in P3 (OR 0.40 (0.18 to 0.93)). CONCLUSIONS This is the first study to examine the 'Hall system' in a non-rehab primary care population. Subgroups classified according to this system appear to have distinct profiles. Further research is needed to better characterise and determine the prognostic implication of these clinically derived subgroups.
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Affiliation(s)
- Lauren S Della Mora
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Arthritis Program, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Arthritis Program, University Health Network, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Arthritis Program, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Yang H, Haldeman S, Lu ML, Baker D. Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors: A Study Using Data From the 2010 National Health Interview Survey. J Manipulative Physiol Ther 2016; 39:459-472. [PMID: 27568831 PMCID: PMC5530370 DOI: 10.1016/j.jmpt.2016.07.004] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objectives of this study were to estimate prevalence of low back pain, to investigate associations between low back pain and a set of emerging workplace risk factors, and to identify worker groups with an increased vulnerability for low back pain in the United States. METHODS The data used for this cross-sectional study came from the 2010 National Health Interview Survey, which was designed to collect data on health conditions and related risk factors from the US civilian population. The variance estimation method was used to compute weighted data for prevalence of low back pain. Multivariable logistic regression analyses stratified by sex and age were performed to determine the odds ratios (ORs) and the 95% confidence interval (CI) for low back pain. The examined work-related psychosocial risk factors included work-family imbalance, exposure to a hostile work environment, and job insecurity. Work hours, occupation, and other work organizational factors (nonstandard work arrangements and alternative shifts) were also examined. RESULTS The prevalence of self-reported low back pain in the previous 3 months among workers in the United States was 25.7% in 2010. Female or older workers were at increased risk of experiencing low back pain. We found significant associations between low back pain and a set of psychosocial factors, including work-family imbalance (OR 1.27, CI 1.15-1.41), exposure to hostile work (OR 1.39, CI 1.25-1.55), and job insecurity (OR 1.44, CI 1.24-1.67), while controlling for demographic characteristics and other health-related factors. Older workers who had nonstandard work arrangements were more likely to report low back pain. Women who worked 41 to 45 hours per week and younger workers who worked >60 hours per week had an increased risk for low back pain. Workers from several occupation groups, including male health care practitioners, female and younger health care support workers, and female farming, fishing, and forestry workers, had an increased risk of low back pain. CONCLUSIONS This study linked low back pain to work-family imbalance, exposure to a hostile work environment, job insecurity, long work hours, and certain occupation groups. These factors should be considered by employers, policymakers, and health care practitioners who are concerned about the impact of low back pain in workers.
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Affiliation(s)
- Haiou Yang
- Center for Occupational and Environmental Health, University of California, Irvine, CA.
| | - Scott Haldeman
- Neurology Department, University of California, Irvine, California; Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA
| | - Ming-Lun Lu
- Division of Applied Research and Technology, National Institute of Occupational Safety and Health, Cincinnati, OH
| | - Dean Baker
- Center for Occupational and Environmental Health, University of California, Irvine, CA
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Hansen BB, Hansen P, Carrino JA, Fournier G, Rasti Z, Boesen M. Imaging in mechanical back pain: Anything new? Best Pract Res Clin Rheumatol 2016; 30:766-785. [DOI: 10.1016/j.berh.2016.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/21/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022]
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Abstract
STUDY DESIGN A systematic review. OBJECTIVES The aim of this study is to evaluate the effectiveness of different types of surgery compared with different types of nonsurgical interventions in adults with symptomatic lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA LSS is a debilitating condition associated with degeneration of the spine with aging. People with LSS experience a range of symptoms, including back pain, leg pain, numbness and tingling in the legs, and reduced physical function. Main treatment options are surgery, physical therapy, exercise, braces, and injections into the spine. METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, five other databases, and two trials registries up to February 2015, reference lists, and conference proceedings related to treatment of the spine. Randomized controlled trials (RCTs) compared surgical versus nonoperative treatments in participants with LSS.Outcomes included quality of life, disability, function, pain, complication rates, and side effects. RESULTS From the 12,966 citations screened, we included five RCTs (643 participants).Three studies compared spine surgery versus various types of nonsurgical treatment. It is difficult to draw conclusions from these studies because nonsurgical treatments were inadequately described. One study that compared surgery versus bracing and exercise found no differences in pain. Another study compared surgery versus spinal injections and found better physical function with injections, and better pain relief with surgery at six weeks. Still another trial compared surgery with an implanted device versus nonsurgical care. This study reported favorable outcomes of surgery for symptoms and physical function. CONCLUSION We cannot conclude on the basis of this review whether surgical or nonsurgical treatment is better for individuals with LSS. Nevertheless, we can report on the high rate of effects reported in three of five surgical groups, ranging from 10% to 24%. No side effects were reported for any of the conservative treatment options. LEVEL OF EVIDENCE 1.
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Sihawong R, Sitthipornvorakul E, Paksaichol A, Janwantanakul P. Predictors for chronic neck and low back pain in office workers: a 1‐year prospective cohort study. J Occup Health 2016; 58:16-24. [DOI: 10.1539/joh.15-0168-oa] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rattaporn Sihawong
- Department of Physical Therapy, Faculty of Allied Health SciencesChulalongkorn UniversityThailand
| | - Ekalak Sitthipornvorakul
- Department of Physical Therapy, Faculty of Allied Health SciencesChulalongkorn UniversityThailand
| | - Arpalak Paksaichol
- Department of Physical Therapy, Faculty of Allied Health SciencesChulalongkorn UniversityThailand
| | - Prawit Janwantanakul
- Department of Physical Therapy, Faculty of Allied Health SciencesChulalongkorn UniversityThailand
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Zaina F, Tomkins‐Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev 2016; 2016:CD010264. [PMID: 26824399 PMCID: PMC6669253 DOI: 10.1002/14651858.cd010264.pub2] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) is a debilitating condition associated with degeneration of the spine with aging. OBJECTIVES To evaluate the effectiveness of different types of surgery compared with different types of non-surgical interventions in adults with symptomatic LSS. Primary outcomes included quality of life, disability, function and pain. Also, to consider complication rates and side effects, and to evaluate short-, intermediate- and long-term outcomes (six months, six months to two years, five years or longer). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, five other databases and two trials registries up to February 2015. We also screened reference lists and conference proceedings related to treatment of the spine. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing surgical versus non-operative treatments in participants with lumbar spinal stenosis confirmed by clinical and imaging findings. DATA COLLECTION AND ANALYSIS For data collection and analysis, we followed methods guidelines of the Cochrane Back and Neck Review Group (Furlan 2009) and those provided in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). MAIN RESULTS From the 12,966 citations screened, we assessed 26 full-text articles and included five RCTs (643 participants).Low-quality evidence from the meta-analysis performed on two trials using the Oswestry Disability Index (pain-related disability) to compare direct decompression with or without fusion versus multi-modal non-operative care showed no significant differences at six months (mean difference (MD) -3.66, 95% confidence interval (CI) -10.12 to 2.80) and at one year (MD -6.18, 95% CI -15.03 to 2.66). At 24 months, significant differences favoured decompression (MD -4.43, 95% CI -7.91 to -0.96). Low-quality evidence from one small study revealed no difference in pain outcomes between decompression and usual conservative care (bracing and exercise) at three months (risk ratio (RR) 1.38, 95% CI 0.22 to 8.59), four years (RR 7.50, 95% CI 1.00 to 56.48) and 10 years (RR 4.09, 95% CI 0.95 to 17.58).Low-quality evidence from one small study suggested no differences at six weeks in the Oswestry Disability Index for patients treated with minimally invasive mild decompression versus those treated with epidural steroid injections (MD 5.70, 95% CI 0.57 to 10.83; 38 participants). Zurich Claudication Questionnaire (ZCQ) results were better for epidural injection at six weeks (MD -0.60, 95% CI -0.92 to -0.28), and visual analogue scale (VAS) improvements were better in the mild decompression group (MD 2.40, 95% CI 1.92 to 2.88). At 12 weeks, many cross-overs prevented further analysis.Low-quality evidence from a single study including 191 participants favoured the interspinous spacer versus usual conservative treatment at six weeks, six months and one year for symptom severity and physical function.All remaining studies reported complications associated with surgery and conservative side effects of treatment: Two studies reported no major complications in the surgical group, and the other study reported complications in 10% and 24% of participants, including spinous process fracture, coronary ischaemia, respiratory distress, haematoma, stroke, risk of reoperation and death due to pulmonary oedema. AUTHORS' CONCLUSIONS We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice. However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment. No clear benefits were observed with surgery versus non-surgical treatment. These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects. High-quality research is needed to compare surgical versus conservative care for individuals with lumbar spinal stenosis.
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Affiliation(s)
- Fabio Zaina
- ISICO (Italian Scientific Spine Institute)Via Roberto Bellarmino 13/1MilanItaly20141
| | - Christy Tomkins‐Lane
- Mount Royal UniversityDepartment of Health and Physical Education4825 Mount Royal Gate SWCalgaryAlbertaCanadaT3E 6K6
| | - Eugene Carragee
- Stanford University ClinicsOrthopaedic Spine CenterRedwood CityCAUSA
| | - Stefano Negrini
- University of Brescia ‐ IRCCS Fondazione Don Gnocchi MilanPhysical and Rehabilitation MedicineViale EuropaBresciaItaly25121
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Mannion AF, Vila-Casademunt A, Domingo-Sàbat M, Wunderlin S, Pellisé F, Bago J, Acaroglu E, Alanay A, Pérez-Grueso FS, Obeid I, Kleinstück FS. The Core Outcome Measures Index (COMI) is a responsive instrument for assessing the outcome of treatment for adult spinal deformity. 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 2015; 25:2638-48. [PMID: 26519374 DOI: 10.1007/s00586-015-4292-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/12/2015] [Accepted: 10/12/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The Core Outcome Measures Index for the back (COMI-back) is a very brief instrument for assessing the main outcomes of importance to patients with back problems (pain, function, symptom-specific well-being, quality of life, disability). However, it might be expected to be less responsive than a disease-specific instrument when evaluating specific pathologies. In patients with adult spinal deformity, we compared the performance of COMI-back with the widely accepted SRS-22 questionnaire. METHODS At baseline and 12 months after non-operative (N = 121) and surgical (N = 83) treatment, patients (175 F, 29 M) completed the following: COMI-back, SRS-22, Oswestry Disability Index (ODI) and SF-36 PCS. At 12 months' follow-up, patients also indicated on a 15-point Global Rating of Change Scale (GRCS) how their back problem had changed relative to 1 year ago. Construct validity for the COMI-back was assessed by the correlation between its scores and those of the comparator instruments; responsiveness was assessed with receiver operating characteristics (ROC) analysis of COMI-back change scores versus the criterion 'treatment success' (dichotomized GRCS). RESULTS Baseline values for the COMI-back showed significant (p < 0.0001) correlations with SRS-22 (r = -0.85), ODI (r = 0.83), and SF-36 PCS (r = -0.82) scores; significantly worse scores for all measures were recorded in the surgical group. The correlation between the change scores (baseline to 12 months) for COMI and SRS-22 was 0.74, and between each of these change scores and the external criterion of treatment success were: COMI-back, r = 0.58; SRS-22, r = -0.58 (each p < 0.0001). The ROC areas under the curve for the COMI-back and SRS-22 change scores were 0.79 and 0.82, respectively. CONCLUSION Both baseline and change scores for the COMI-back correlated strongly with those of the SRS-22, and differed significantly in surgical and non-operative patients, suggesting good construct validity. With the "change in the back problem" serving as external criterion, COMI-back showed similar external responsiveness to SRS-22. The COMI-back was well able to detect important change. Coupled with its brevity, which minimizes patient burden, these favourable psychometric properties suggest the COMI-back is a suitable instrument for use in registries and can serve as a valid instrument in clinical studies emerging from such data pools.
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Affiliation(s)
- A F Mannion
- Spine Center Division, Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| | - A Vila-Casademunt
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - M Domingo-Sàbat
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - S Wunderlin
- Spine Center Division, Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - F Pellisé
- Spine Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - J Bago
- Spine Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - E Acaroglu
- Spine Surgery Unit, Ankara Spine Center, Ankara, Turkey
| | - A Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - F S Pérez-Grueso
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - I Obeid
- Spine Surgery Unit, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France
| | - F S Kleinstück
- Spine Center Division, Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
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Clement RC, Welander A, Stowell C, Cha TD, Chen JL, Davies M, Fairbank JC, Foley KT, Gehrchen M, Hagg O, Jacobs WC, Kahler R, Khan SN, Lieberman IH, Morisson B, Ohnmeiss DD, Peul WC, Shonnard NH, Smuck MW, Solberg TK, Stromqvist BH, Hooff MLV, Wasan AD, Willems PC, Yeo W, Fritzell P. A proposed set of metrics for standardized outcome reporting in the management of low back pain. Acta Orthop 2015; 86:523-33. [PMID: 25828191 PMCID: PMC4564773 DOI: 10.3109/17453674.2015.1036696] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Outcome measurement has been shown to improve performance in several fields of healthcare. This understanding has driven a growing interest in value-based healthcare, where value is defined as outcomes achieved per money spent. While low back pain (LBP) constitutes an enormous burden of disease, no universal set of metrics has yet been accepted to measure and compare outcomes. Here, we aim to define such a set. PATIENTS AND METHODS An international group of 22 specialists in several disciplines of spine care was assembled to review literature and select LBP outcome metrics through a 6-round modified Delphi process. The scope of the outcome set was degenerative lumbar conditions. RESULTS Patient-reported metrics include numerical pain scales, lumbar-related function using the Oswestry disability index, health-related quality of life using the EQ-5D-3L questionnaire, and questions assessing work status and analgesic use. Specific common and serious complications are included. Recommended follow-up intervals include 6, 12, and 24 months after initiating treatment, with optional follow-up at 3 months and 5 years. Metrics for risk stratification are selected based on pre-existing tools. INTERPRETATION The outcome measures recommended here are structured around specific etiologies of LBP, span a patient's entire cycle of care, and allow for risk adjustment. Thus, when implemented, this set can be expected to facilitate meaningful comparisons and ultimately provide a continuous feedback loop, enabling ongoing improvements in quality of care. Much work lies ahead in implementation, revision, and validation of this set, but it is an essential first step toward establishing a community of LBP providers focused on maximizing the value of the care we deliver.
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Affiliation(s)
- R Carter Clement
- Department of Orthopaedic Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | | | - Caleb Stowell
- International Consortium for Health Outcomes Measurement, Boston, MA, USA
| | - Thomas D Cha
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - John L Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | | | - Kevin T Foley
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Martin Gehrchen
- Department of Orthopaedic Surgery, Spine Section, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Olle Hagg
- Spine Center Göteborg, Gothenburg, Sweden
| | - Wilco C Jacobs
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Safdar N Khan
- Department of Orthopaedics, Division of Spine, Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | | | | | | | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center and Medical Center Haaglanden, Leiden and The Hague, the Netherlands
| | - Neal H Shonnard
- Director, Spine SCOAP Collaborative, Rainier Orthopedic Institute, Puyallup, WA, US
| | - Matthew W Smuck
- Department of Orthopaedic Surgery, PM&R Section, Stanford University, Palo Alto, CA, USA
| | - Tore K Solberg
- Department of Ophthalmology and Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway,The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Bjorn H Stromqvist
- Department of Orthopedics, Clinical Sciences Lund, Lund University Hospital, Lund, Sweden
| | | | - Ajay D Wasan
- Department of Anesthesiology, University of Pittsburgh Medical Center Pittsburgh, PA, USA
| | - Paul C Willems
- Maastricht University Medical Center, Maastricht, the Netherlands
| | - William Yeo
- Orthopaedic Diagnostic Centre, Singapore General Hospital, Singapore
| | - Peter Fritzell
- Department of Orthopaedic Surgery, Ryhov Hospital, Jönköping, Sweden,Registry Manager, Swespine
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