1
|
Cottone KA, Schumacher MR, Young JL, Rhon DI. The majority of clinical trials assessing mobilization and manipulation for neck pain lack a pragmatic approach: a systematic review of 174 trials. J Man Manip Ther 2024:1-17. [PMID: 38525785 DOI: 10.1080/10669817.2024.2327127] [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: 12/19/2023] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Disorders of the cervical spine are some of the costliest musculoskeletal conditions to manage globally. Joint mobilization and manipulation have been shown to be an effective treatment for neck pain. However, the generalizability and clinical translation depends on the nature of the trial designs that inform its use. The extent to which randomized control trials (RCTs) assessing manual therapy treatments for cervical spine disorders fall on the efficacy (explanatory) -effectiveness (pragmatic) spectrum often informs how the findings are translated into clinical practice. OBJECTIVE The aim of this systematic review was to determine where RCTs of manual therapy for neck disorders fall on the efficacy-effectiveness spectrum. METHODS A search of three electronic databases including PubMed, CINAHL, and CENTRAL were completed for trials published from inception to May 2023. RCTs in which joint mobilization or manipulation were used to treat cervical spine disorders were assessed on the effectiveness-efficacy spectrum using the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool and risk of bias using the Revised Cochrane Risk of Bias tool. RESULTS A total of 174 trials met eligibility. RITES domain two trial setting (71.3% vs 16.1%), domain three flexibility of intervention(s) (62.1% vs 23%), and domain four clinical relevance of experimental and comparison intervention(s) (51.7% vs 29.3%) all favored efficacy over effectiveness. Domain one participant characteristic(s) had a slightly greater emphasis on effectiveness compared to efficacy (36.8% vs 44.8%). Most studies (96%) had at least some risk of bias. CONCLUSION Over half of the RCTs assessing the treatment effect of joint mobilization and manipulation for neck pain favor efficacy (explanatory) over effectiveness (pragmatic) designs. Future RCTs on this topic should consider a greater emphasis on pragmatic trial design components in order to better reflect real-world translation to clinical practice.
Collapse
Affiliation(s)
- Kyle A Cottone
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Physical Therapy and Health Science, Bradley University, Peoria, IL, USA
| | - Matthew R Schumacher
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Doctor of Physical Therapy Program, University of Mary, Bismarck, ND, USA
| | - Jodi L Young
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| |
Collapse
|
2
|
Lauridsen HH, Meldgaard E, Hestbæk L, Hansen GK. Development of the Young Disability Questionnaire (spine) for children with spinal pain: field testing in Danish school children. BMJ Open 2023; 13:e064382. [PMID: 37197823 DOI: 10.1136/bmjopen-2022-064382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE The objective of this study was to finalise the development of the Young Disability Questionnaire (YDQ-spine) to measure the consequences of neck, midback and low back pain, relevant for schoolchildren aged 9-12 years. DESIGN A cross-sectional field test of the YDQ-spine was carried out. SETTING Danish primary schools. PARTICIPANTS Children aged 9-12 years from all Danish schools were invited to complete the questionnaire. METHODS Eight hundred and seventy-three schools were invited to participate. Consenting schools received information material, instructions and a link to an electronic version of the prefinal YDQ-spine. Local teachers distributed the electronic YDQ-spine to children aged 9-12 years. Descriptive statistics and item characteristics were carried out. Item reduction was performed using partial interitem correlations (scrutinising correlations>0.3) and factor analyses (items loading>0.3 were retained) to eliminate redundant items and to obtain insight into the structure of the questionnaire. RESULTS A total of 768 children from 20 schools answered of the questionnaire and 280 fulfilled the inclusion criteria of having back and/or neck pain (36%). Multisite pain was reported by 38%. Partial interitem correlations and factor analyses resulted in elimination of four items which were considered redundant leaving 24 items in the final YDQ-spine with an optional section on what matters most to the child. The factor analyses showed a two-factor structure with a physical component (13 items) and a psychosocial component (10 items) in addition to one standalone item (sleep). CONCLUSION The YDQ-spine is a novel questionnaire with satisfactory content validity measuring physical and psychosocial components (including sleep disturbances) of spinal pain in children aged 9-12 years. It also offers an optional section on what matters most to the child allowing targeted care in clinical practice.
Collapse
Affiliation(s)
- Henrik Hein Lauridsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Emilie Meldgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lise Hestbæk
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark
| | - Gabrielle Kristine Hansen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Fältström A, Skillgate E, Weiss N, Källberg H, Lyberg V, Waldén M, Hägglund M, Asker M, Tranaeus U. Lifestyle characteristics in adolescent female football players: data from the Karolinska football Injury Cohort. BMC Sports Sci Med Rehabil 2022; 14:212. [PMID: 36517880 PMCID: PMC9753279 DOI: 10.1186/s13102-022-00603-1] [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: 08/21/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Normative values of lifestyle characteristics in adolescent female football players may be used by clinicians and coaches to take actions because the potential important for well-being, performance on the pitch, and risk of injury. The aim was to report descriptive characteristics of lifestyle factors in adolescent female football players and potential changes over 1 year. METHODS We included 419 adolescent competitive female football players from 12 clubs and 27 teams (age 14 ± 1 years, range 12-17 years) and 286 were followed over 1 year. The players completed an extensive questionnaire regarding demographics, football-related factors, and lifestyle factors including tobacco consumption, alcohol use, medicine intake, eating and sleeping habits, well-being, stress, coping, and passion. Baseline data are presented for the total cohort and separately for 4 age groups (12, 13, 14, and 15-17 years). RESULTS 12% skipped breakfast, 8% skipped lunch and 11% used protein supplements several days per week. 16% slept less than 8 h/night, 8% had impaired sleep with daytime consequences, and 22% stated that they were tired in daily activities several days per week. 32% experienced stress some or most days/week and 24% were classified as having psychological distress. Medicine intake (23% vs. 34%), skipping breakfast or lunch several days per week (10% vs. 47% and 20 vs. 33%), tiredness (20% vs. 27%), stress (26% vs. 40%), and psychological distress (27% vs. 37%) increased significantly (P = 0.031 to < 0.001) at the 1-year follow-up. CONCLUSION Many adolescent female football players skip breakfast and lunch, have insufficient sleep, experience stress and are classified as having psychological distress. These factors increased over 1 year.
Collapse
Affiliation(s)
- Anne Fältström
- grid.445308.e0000 0004 0460 3941Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden ,grid.5640.70000 0001 2162 9922Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.413253.2Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden
| | - Eva Skillgate
- grid.445308.e0000 0004 0460 3941Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Unit of Intervention and Implementation for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nathan Weiss
- grid.445308.e0000 0004 0460 3941Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Unit of Intervention and Implementation for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Källberg
- grid.445308.e0000 0004 0460 3941Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden ,grid.419734.c0000 0000 9580 3113Unit of analysis, Department of Public Health, Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Victor Lyberg
- grid.445308.e0000 0004 0460 3941Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
| | - Markus Waldén
- Unit of Public Health, Department of Health, Medicine and Caring Sciences, Linköping, Sweden ,GHP Ortho Center Skåne, Malmö, Sweden
| | - Martin Hägglund
- grid.5640.70000 0001 2162 9922Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Sport Without Injury ProgrammE (SWIPE), Linköping University, Linköping, Sweden
| | - Martin Asker
- grid.445308.e0000 0004 0460 3941Department of Health Promotion Science, Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Unit of Intervention and Implementation for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,Naprapathögskolan, Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
| | - Ulrika Tranaeus
- grid.4714.60000 0004 1937 0626Unit of Intervention and Implementation for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.416784.80000 0001 0694 3737Department of Physiology, Nutrition, Biomechanic, Sport Performance & Exercise Research & Innovation Center - Stockholm, SPERIC-S, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| |
Collapse
|
4
|
Whale K, Dennis J, Wylde V, Beswick A, Gooberman-Hill R. The effectiveness of non-pharmacological sleep interventions for people with chronic pain: a systematic review and meta-analysis. BMC Musculoskelet Disord 2022; 23:440. [PMID: 35546397 PMCID: PMC9092772 DOI: 10.1186/s12891-022-05318-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/24/2022] [Indexed: 02/25/2023] Open
Abstract
Objective About two thirds of people with chronic pain report problems sleeping. We aimed to evaluate the effectiveness of non-pharmacological sleep interventions for improving sleep in people with chronic pain. Design We conducted a systematic review of non-pharmacological and non-invasive interventions to improve sleep quality or duration for adults with chronic non-cancer pain evaluated in a randomised controlled trial. Our primary outcome of interest was sleep; secondary outcomes included pain, health-related quality of life, and psychological wellbeing. We searched the Cochrane Library, MEDLINE, Embase, PsycINFO and CINAHL from inception to April 2020. After screening, two reviewers evaluated articles and extracted data. Meta-analysis was conducted using a random effects model. Risk of bias was assessed with the Cochrane tool. Results We included 42 trials involving 3346 people randomised to 94 groups, of which 56 received an intervention targeting sleep. 10 studies were of fair and 32 of good methodological quality. Overall risk of bias was judged to be low in 11, high in 10 and unclear in 21 studies. In 9 studies with 385 people randomised, cognitive behavioural therapy for insomnia showed benefit post-treatment compared with controls for improved sleep quality, standardised mean difference − 1.23 (95%CI -1.76, − 0.70; p < 0.00001). The effect size was only slightly reduced in meta-analysis of 3 studies at low risk of bias. The difference between groups was lower at 3 and 6 months after treatment but still favoured cognitive behavioural therapy for insomnia. Pain, anxiety and depression were reduced post-treatment, but evidence of longer term benefit was lacking. There was no evidence that sleep hygiene interventions were effective in improving sleep and there was some evidence in comparative studies to suggest that cognitive behavioural therapy for insomnia was more effective than sleep hygiene. Numerous other interventions were evaluated in small numbers of studies, but evidence was insufficient to draw conclusions about effectiveness. Conclusions Cognitive behavioural therapy for insomnia is an effective treatment to improve sleep for people with chronic pain, but further high-quality primary research is required to explore combined CBT content that will ensure additional improvements to pain, quality of life and psychological health and longer-term maintenance of benefits. Primary research is also needed to evaluate the effectiveness of interventions for which insufficient evidence exists. Trial registration PROSPERO registration number: CRD42019093799. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05318-5.
Collapse
Affiliation(s)
- Katie Whale
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK. .,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.
| | - Jane Dennis
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Andrew Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| |
Collapse
|
5
|
Holm LW, Bohman T, Lekander M, Magnusson C, Skillgate E. Risk of transition from occasional neck/back pain to long-duration activity limiting neck/back pain: a cohort study on the influence of poor work ability and sleep disturbances in the working population in Stockholm County. BMJ Open 2020; 10:e033946. [PMID: 32499260 PMCID: PMC7282292 DOI: 10.1136/bmjopen-2019-033946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The prevalence of neck/back pain (NBP) is high worldwide. Limited number of studies have investigated workers with occasional NBP regarding the risk of developing long-duration activity limiting NBP (LNBP). The objectives were to assess (1) the effect of poor work ability and sleep disturbances in persons with occasional NBP on the risk of LNBP, and (2) the interaction effect of these exposures. DESIGN Cohort study based on three subsamples from the Stockholm Public Health Cohort. SETTINGS The working population in Stockholm County. PARTICIPANTS Persons aged 18-60 years, reporting occasional NBP the past 6 months at baseline year 2010 (n=16 460). MEASURES Work ability was assessed with items from the Work Ability Index, perceived mental and/or physical work ability. Sleep disturbances were self-reported current mild/severe disturbances. The outcome in year 2014 was reporting NBP the previous 6 months, occurring ≥couple of days per week and resulting in decreased work ability/restricted other daily activities. The additive effect of having both poor work ability and sleep disturbances was modelled with a dummy variable, including both exposures. Poisson log-linear regression was used to calculate risk ratios (RRs) and 95% CIs. RESULTS At follow-up, 9% had developed LNBP. Poor work ability and sleep disturbances were independent risk factors for LNBP; adjusted RR 1.7 (95% CI: 1.4 to 2.0) and 1.4 (95% CI: 1.2 to 1.5), respectively. No additive interaction was observed. CONCLUSION Workers with occasional NBP who have poor work ability and/or sleep disturbances are at risk of developing LNBP. Having both conditions does not exceed additive risk.
Collapse
Affiliation(s)
- Lena W Holm
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tony Bohman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - C Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Eva Skillgate
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Sophiahemmet University, Stockholm, Sweden
| |
Collapse
|
6
|
Husak AJ, Bair MJ. Chronic Pain and Sleep Disturbances: A Pragmatic Review of Their Relationships, Comorbidities, and Treatments. PAIN MEDICINE 2020; 21:1142-1152. [DOI: 10.1093/pm/pnz343] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AbstractObjectiveThe objective of this review is to answer three questions: 1) How are chronic pain severity and pain duration affected in patients with chronic pain and sleep disturbances that occur simultaneously? 2) What are common comorbidities and pain-related symptoms seen in patients with chronic pain and sleep disturbances? and 3) What are potentially effective pharmacological and nonpharmacological treatment options for both conditions?MethodsOvid Medline and PubMed were searched. Search terms included sleep wake disorder, chronic pain, fibromyalgia, treatment outcome, psychotherapy, complementary therapies, and therapeutics. Studies that assessed outcomes between individuals with chronic pain and those with concurrent chronic pain and sleep disturbances were included. Randomized controlled clinical trials of treatments for both conditions were included.ResultsSixteen studies indicated that patients with both chronic pain and sleep disturbances have greater pain severity, longer duration of pain, greater disability, and are less physically active than those without sleep disturbances. Patients with both conditions are more likely to have concurrent depression, catastrophizing, anxiety, and suicidal ideation. Thirty-three randomized controlled trials assessed treatment for both chronic pain and sleep disturbances. Pregabalin was the most frequently studied medication, showing improvement in pain and sleep symptoms. Cognitive behavioral therapy for insomnia showed long-term improvement in sleep for patients with chronic pain.ConclusionsIndividuals with chronic pain and sleep disturbances have greater symptom severity, longer duration of symptoms, more disability, and additional comorbidities. Pharmacological and nonpharmacological treatments may be useful in the treatment of concurrent chronic pain and sleep disturbances, but further study is needed.
Collapse
Affiliation(s)
- Aubrey J Husak
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew J Bair
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- VA Health Services Research and Development Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Indianapolis, Indiana
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| |
Collapse
|
7
|
Benoist M. The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "medical" articles in the European Spine Journal, 2016. 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; 26:1-10. [PMID: 27900554 DOI: 10.1007/s00586-016-4886-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Michel Benoist
- Département de Rhumatologie, Service de Chirurgie Orthopédique, Hôpital Beaujon, 100 Boulevard Général Leclerc, 92118, Clichy, France.
| |
Collapse
|