1
|
Gilanyi YL, Rizzo RRN, Sharma S, Venter M, McAuley JH, Jones MD. A Qualitative Study Identifying Barriers and Enablers to Exercise Adherence in People with Chronic Low Back Pain. "It's a personal journey". THE JOURNAL OF PAIN 2024; 25:104488. [PMID: 38336028 DOI: 10.1016/j.jpain.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Exercise leads to clinically meaningful pain reductions in people with chronic low back pain and is recommended as a first line treatment. The benefits of exercise for chronic low back pain decrease over time with a lack of long-term exercise adherence as a potential reason for this decreasing effect. We aimed to identify the barriers and enablers to exercise adherence from the perspective of people with chronic low back pain. This qualitative study was underpinned by a constructivist epistemology and used a critical realist ontological perspective. Adults (18-65 years) with chronic low back pain who had exercised since the onset of their back pain were recruited to participate in focus groups and individual interviews. Audio data were transcribed and then analysed in 2 stages 1) inductive coding using reflexive thematic analysis, followed by 2) deductive analysis through mapping codes onto the Theoretical Domains Framework. Five enablers and 3 barriers were identified across 6 of the 14 Theoretical Domain Framework domains. Exercise identity and confidence in deciding to self-manage pain were enablers, whereas beliefs about the consequences of exercise, exercise context, and relationships could function as either barriers or enablers. These barriers and enablers were complex and fluid, with participants reporting conflicting barriers and enablers that varied, depending on context. These findings improve our understanding of the barriers and enablers to exercise adherence from the individual perspective of people with chronic low back pain and can be utilised for more effective exercise treatment in this population. PERSPECTIVE: This article presents the barriers and enablers to exercise adherence from the perspective of people with chronic low back pain. These perspectives may aid to individualise and optimise exercise treatment, improve its long-term adherence and therefore its effectiveness for chronic low back pain.
Collapse
Affiliation(s)
- Yannick L Gilanyi
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Rodrigo R N Rizzo
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Martjie Venter
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| |
Collapse
|
2
|
Sharif S, Jazaib Ali MY, Kirazlı Y, Vlok I, Zygourakis C, Zileli M. Acute back pain: The role of medication, physical medicine and rehabilitation: WFNS spine committee recommendations. World Neurosurg X 2024; 23:100273. [PMID: 38807862 PMCID: PMC11130729 DOI: 10.1016/j.wnsx.2024.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/01/2024] [Indexed: 05/30/2024] Open
Abstract
Objectives To formulate the most current, evidence-based recommendations for the role of medication, physical medicine, and rehabilitation in the management of acute low back pain lasting <4 weeks. Methods A systematic literature search in PubMed and Google Scholar databases was performed from 2012 to 2022 using the search terms "acute low back pain," "drugs," "bed rest," "physical medicine," rehabilitation." Standardized screening criteria resulted in a total of 39 articles that were analyzed, including 16 RCTs, 8 prospective studies, 6 retrospective studies, and 9 systematic reviews. This up-to-date information was reviewed and presented at two separate meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. Two rounds of the Delphi method were utilized to vote on the statements and arrive at a positive or negative consensus. Results and conclusion The WFNS Spine Committee finalized twelve recommendation guidelines on the role of medication, physical medicine and rehabilitation in the management of acute LBP. We advocate for a uniform approach to the treatment of these patients, including proper patient education and utilizing drugs with proven efficacy and minimal side effects. First-line pharmacologic agents are acetaminophen and NSAIDs; muscle relaxants can be used for spasms and pain reduction, and opioids should be minimized. Continued activity, rather than bed rest, is recommended, and lumbar spine orthotics may be used to reduce pain and augment functional status. Thermotherapy, cryotherapy, TENs, spinal manipulative therapy, and acupuncture may all be used as adjuncts to improve acute LBP.
Collapse
Affiliation(s)
- Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | | | - Yeşim Kirazlı
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | - Ian Vlok
- Department of Neurosurgery, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Corinna Zygourakis
- Department of Neurosurgery, Sanko University Faculty of Medicine, Gaziantep, Turkey
| | - Mehmet Zileli
- Department of Neurosurgery, Stanford University School of Medicine, California, USA
| |
Collapse
|
3
|
Vader K, Donnelly C, Lane T, Newman G, Tripp DA, Miller J. Accessing care within team-based models of primary care for the management of chronic low back pain in Ontario, Canada: a qualitative study of patient experiences. Disabil Rehabil 2024:1-10. [PMID: 38949048 DOI: 10.1080/09638288.2024.2366000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/05/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE To understand experiences accessing care within team-based primary care models among adults with chronic low back pain (LBP). MATERIALS & METHODS We conducted an interpretive description qualitative study and collected data using one-to-one semi-structured interviews. Participants were recruited from publicly funded, team-based primary care models in Ontario, Canada. RESULTS We completed interviews with 16 adults with chronic LBP (9 women; median age of 66). Participants expressed a desire to access care from team-based models of primary care in hopes of alleviating pain and its impacts on daily life. Due to no direct out-of-pocket costs, co-location of healthcare providers, and the use of technology and virtual care, participants described an ease of accessing interprofessional care within team-based primary care models. Finally, participants described experiences with and expectations for timely access to care, being heard and understood by healthcare providers, and receiving coordinated care by an interprofessional team. CONCLUSIONS Adults living with chronic LBP described overall positive experiences and specific expectations when accessing care within team-based models of primary care, whereby they experienced an ease of accessing interprofessional care with the hope of alleviating pain and its impacts. Results may be transferable to other chronic pain conditions and health system contexts.
Collapse
Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Therese Lane
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Gillian Newman
- Patient Engagement Research Ambassadors, Institute of Musculoskeletal Health and Arthritis, Canadian Institutes of Health Research, Toronto, Ontario, Canada
- Curvy Girls Scoliosis, Toronto, Ontario, Canada
| | - Dean A Tripp
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
- Department of Anesthesiology, Queen's University, Kingston, Ontario, Canada
- Department of Urology, Queen's University, Kingston, Ontario, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
4
|
Alves GS, Vera GEZ, Maher CG, Ferreira GE, Machado GC, Buchbinder R, Pinto RZ, Oliveira CB. Clinical care standards for the management of low back pain: a scoping review. Rheumatol Int 2024; 44:1197-1207. [PMID: 38421427 PMCID: PMC11178557 DOI: 10.1007/s00296-024-05543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
The objective of this study is to compare and contrast the quality statements and quality indicators across clinical care standards for low back pain. Searches were performed in Medline, guideline databases, and Google searches to identify clinical care standards for the management of low back pain targeting a multidisciplinary audience. Two independent reviewers reviewed the search results and extracted relevant information from the clinical care standards. We compared the quality statements and indicators of the clinical care standards to identify the consistent messages and the discrepancies between them. Three national clinical care standards from Australia, Canada, and the United Kingdom were included. They provided from 6 to 8 quality statements and from 12 to 18 quality indicators. The three standards provide consistent recommendations in the quality statements related to imaging, and patient education/advice and self-management. In addition, the Canadian and Australian standards also provide consistent recommendations regarding comprehensive assessment, psychological support, and review and patient referral. However, the three clinical care standards differ in the statements related to psychological assessment, opioid analgesics, non-opioid analgesics, and non-pharmacological therapies. The three national clinical care standards provide consistent recommendations on imaging and patient education/advice, self-management of the condition, and two standards (Canadian and Australian) agree on recommendations regarding comprehensive assessment, psychological support, and review and patient referral. The standards differ in the quality statements related to psychological assessment, opioid prescription, non-opioid analgesics, and non-pharmacological therapies.
Collapse
Affiliation(s)
- Gabriel S Alves
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil
| | - Gustavo E Z Vera
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney, Royal Prince Alfred Hospital, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, P. O. Box M179, Camperdown, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, The University of Sydney, Royal Prince Alfred Hospital, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, P. O. Box M179, Camperdown, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, The University of Sydney, Royal Prince Alfred Hospital, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, P. O. Box M179, Camperdown, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rafael Z Pinto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Crystian B Oliveira
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil.
- Institute for Musculoskeletal Health, The University of Sydney, Royal Prince Alfred Hospital, Sydney Local Health District, Level 10N, King George V Building, Missenden Road, P. O. Box M179, Camperdown, 2050, Australia.
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
5
|
Maher C, Lin CWC. Welcome new evidence on self-management of back pain. THE LANCET. RHEUMATOLOGY 2024; 6:e412-e413. [PMID: 38824936 DOI: 10.1016/s2665-9913(24)00116-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Chris Maher
- The University of Sydney, Sydney, NSW2050, Australia.
| | | |
Collapse
|
6
|
Jones CMP, Underwood M, Chou R, Schoene M, Sabzwari S, Cavanagh J, Lin CWC. Analgesia for non-specific low back pain. BMJ 2024; 385:e080064. [PMID: 38936847 PMCID: PMC11208989 DOI: 10.1136/bmj-2024-080064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Caitlin M P Jones
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Camperdown NSW, Australia
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, USA
| | - Mark Schoene
- Cochrane Collaboration, Back and Neck Review Group, Newbury MA, USA
| | - Saniya Sabzwari
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Camperdown NSW, Australia
| |
Collapse
|
7
|
Varrassi G, Hanna M, Coaccioli S, Fabrizzi P, Baldini S, Kruljac I, Brotons C, Perrot S. Dexketoprofen Trometamol and Tramadol Hydrochloride Fixed-Dose Combination in Moderate to Severe Acute Low Back Pain: A Phase IV, Randomized, Parallel Group, Placebo, Active-Controlled Study (DANTE). Pain Ther 2024:10.1007/s40122-024-00623-4. [PMID: 38922520 DOI: 10.1007/s40122-024-00623-4] [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: 04/25/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION Dexketoprofen/tramadol 25/75 mg (DKP/TRAM) is a fixed-dose combination of a cyclooxygenase inhibitor and opioid receptor agonist. To better understand the efficacy and safety of DKP/TRAM in the treatment of moderate to severe acute lower back pain (LBP) with or without radiculopathy, we carried out a large explorative phase IV international, multicenter, prospective, randomized, double-blind, parallel group, placebo-controlled study (DANTE). METHODS A total of 538 patients with or without a history of LBP and experiencing acute LPB of moderate to severe intensity [Numerical Rating Scale-Pain Intensity (NRS-PI) score > 5] were randomized 4:4:1:1 to DKP/TRAM 25/75 mg every 8 h (n = 211), tramadol (TRAM) 100 mg (n = 207), placebo-matched DKP/TRAM (n = 59), or placebo-matched TRAM (n = 61). RESULTS The proportion of patients achieving the primary endpoint, defined as the time to first achieve NRS-PI score < 4 or pain intensity reduction ≥ 30% from drug intake up to 8 h after the first dose, was higher in the DKP/TRAM arm than in the placebo group, but the difference was not statistically significant (46.1% vs. 42.6%, respectively; hazard ratio 1.11; 95% confidence interval 0.775, 1.595; p = 0.566). DKP/TRAM achieved superiority over TRAM in total pain relief at 4, 6, and 8 h (p < 0.05). Conversely, in relation to the secondary endpoints, a significantly greater reduction in NRS-PI score was seen with DKP/TRAM versus placebo starting from 1 h, and this reduction remained numerically lower throughout 8 h. Summed pain intensity difference values were also significantly lower at 4, 6, and 8 h with DKP/TRAM compared to TRAM (p < 0.05). Overall, DKP/TRAM was well tolerated. CONCLUSION Although the primary endpoint was not met, secondary efficacy analyses suggest the superiority of DKP/TRAM over placebo and TRAM alone in terms of total pain relief. DKP/TRAM can be considered to be an effective and safe option for the treatment of moderate to severe acute LBP. DANTE STUDY REGISTRATION EudraCT number: 2019-003656-37; ClinicalTrials.gov Identifier: NCT05170841.
Collapse
Affiliation(s)
| | - Magdi Hanna
- Analgesics and Pain Research (APR) Ltd, Beckenham, UK
| | | | - Paolo Fabrizzi
- A. Menarini Industrie Farmaceutiche Riunite S.r.l., Florence, Italy
| | - Simone Baldini
- A. Menarini Industrie Farmaceutiche Riunite S.r.l., Florence, Italy
| | - Ivan Kruljac
- Poliklinika SOLMED d.o.o., Preradovićeva ulica 20, 10000, Zagreb, Croatia
| | - Carles Brotons
- Sardenya Primary Health Care Center, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Serge Perrot
- Pain Center, INSERM U987, Hôpital Cochin, University of Paris, Paris, France
| |
Collapse
|
8
|
Bogaert L, Brumagne S, Léonard C, Lauwers A, Peters S. Physiotherapist- and patient-reported barriers to guideline implementation of active physiotherapeutic management of low back pain: A theory-informed qualitative study. Musculoskelet Sci Pract 2024; 73:103129. [PMID: 38943770 DOI: 10.1016/j.msksp.2024.103129] [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] [Received: 01/06/2024] [Revised: 05/30/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Adoption of low back pain (LBP) guidelines in physiotherapeutic management is a well-documented problem. Thereby, an in-depth understanding of the barriers to implement an active approach for both patients and physiotherapists is needed. DESIGN Semi-structured interviews were conducted with physiotherapists and patients with non-specific LBP. Interviews, guided by the Theoretical Domains Framework (TDF), were analyzed using the Qualitative Analysis Guide of Leuven. RESULTS A total of 20 participants were interviewed, including ten physiotherapists and ten patients. Our findings reveal that patients and physiotherapists face each 23 barriers spanning 14 TDF domains. The TDF domain "social influences" revealed the most barriers, followed by "beliefs about consequences" and "environmental context" for patients and physiotherapists, respectively. Five barriers did overlap between both groups (lack of guideline awareness, incorrect exercise performance, interdisciplinary communication gaps, time constraints and challenges in patient compliance). CONCLUSIONS Barriers to LBP guideline recommended physiotherapeutic practices span all 14 TDF domains. Consequently, future implementation interventions need to address multiple TDF domains for effective LBP guideline implementation.
Collapse
Affiliation(s)
- Liedewij Bogaert
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium; REVAL Rehabilitation Research, Hasselt University, Diepenbeek, Belgium.
| | - Simon Brumagne
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Amber Lauwers
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Sanne Peters
- School of Health Sciences, University of Melbourne, Australia
| |
Collapse
|
9
|
Baig AAM, Ansari B, Ahmed SI, Ishaque F, Farooqui WA. Association of demographics, lumbar active range of motion and disability in chronic low back: a baseline data analysis of a randomized controlled trial from Pakistan. BMC Musculoskelet Disord 2024; 25:489. [PMID: 38909184 PMCID: PMC11193308 DOI: 10.1186/s12891-024-07613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 06/20/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND The disability and significant economic costs accredited to Low back pain (LBP) are likely to rise which is an essential problem in low and middle-income countries like Pakistan. The associated factors of LBP are age, sex, and race including physical activity, high spinal load, lifting, bending, and twisting occupations. The literature highlighted there is substantial differences in associated factors of LBP within available studies in developing countries. The objective is to investigate the association of demographic factors and lumbar range of motion with disability in patients with chronic low back. METHODS A baseline data analysis was performed as an analytical cross-sectional study among 150 patients with chronic low back in a randomized controlled trial with a duration from March 2020 and January 2021. After recording demographics, Modified-Modified Schober's test was used to measure lumbar flexion and extension and Oswestry disability index for disability. After the descriptive analysis the continuous variables, age and pain were analyzed with Spearman's correlation. Variables that were significant in bivariate analysis were then fitted in a multivariable linear regression. The Kruskal-Wallis test was used to analyze variations of disability in gender, marital status, work status, education level, and duration of pain. The p-value of 0.05 was significant. RESULTS The results showed a significant correlation between age and pain in sitting (rh=-0.189, p = 0.021 and rh = 0.788, p < 0.001) with the disability but no significant effects of age and pain in sitting (B=-0.124, p = 0.212 and B = 1.128, p = 0.082) on disability were found. The decrease in lumbar flexion and extension was found to increase disability (B=-6.018 and - 4.032 respectively with p < 0.001). Female gender (x2(1) = 15.477, p = < 0.001) and unmarried marital status (x2(1) = 4.539, p = 0.033) had more disability than male gender and married marital status, respectively. There was a significance between groups of the duration of pain regarding disability (x2 (2) = 70.905, p < 0.001). Age, education level, and work status showed no significance (p > 0.05). CONCLUSIONS The female gender and unmarried marital status are associated with functional disability. Decreased lumbar range of motion accompanies more disability, while age, education level, and work status do not effect on disability.
Collapse
Affiliation(s)
| | - Basit Ansari
- Department of Health, Physical Education and Sports Sciences, University of Karachi, Karachi, Pakistan
| | - Syed Imran Ahmed
- Faculty of Health Sciences, Iqra University, North Campus, Karachi, Pakistan
| | - Farhan Ishaque
- Department of Physiotherapy, Dow Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
| | | |
Collapse
|
10
|
Park BH, Han JH, Park JH, Min TW, Lee HJ, Lee YJ, Lee SH, Park KS, Ha IH. Effectiveness and safety of motion-style acupuncture treatment using traction for inpatients with acute low back pain caused by a traffic accident: A randomized controlled trial. Medicine (Baltimore) 2024; 103:e38590. [PMID: 38905412 PMCID: PMC11191944 DOI: 10.1097/md.0000000000038590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/24/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Musculoskeletal symptoms, such as neck pain and low back pain (LBP) are common after a traffic accident (TA). While motion-style acupuncture treatment (MSAT) is effective in relieving pain, MSAT using traction (T-MSAT) has rarely been studied, and evidence for its efficacy and safety is lacking. To address this gap, this study aimed to assess the effectiveness and safety of T-MSAT for pain and functional disturbances in patients with acute LBP caused by a TA. METHODS This two-armed, parallel, assessor blinded randomized controlled trial, conducted at Jaseng Hospital of Korean Medicine, included 100 patients with acute LBP occurring within 1 week of a TA. The participants were randomly allocated (1:1 ratio) to receive either combined T-MSAT and integrative Korean medicine treatment (IKMT) or only conventional IKMT, applied for 3 consecutive days after admission. The primary outcome was the difference between numerical rating scale (NRS) scores for LBP at baseline and after treatment completion on day 4 after admission. RESULTS At the primary endpoint, the difference in NRS scores for LBP between the T-MSAT and control groups was 0.94 (95% confidence interval [CI] 0.40-1.48). The T-MSAT group showed a significantly lower NRS score for LBP than the control group. Differences in visual analogue scale (VAS) scores between the T-MSAT and control groups were significant at baseline and discharge. The area under the curve of the VAS score showed a significant difference (-46.86 [95% CI -85.13 to -8.59]), indicating faster pain reduction in the T-MSAT group than in the control group. Recovery (30% pain reduction) was achieved more rapidly in the T-MSAT group than in the control group (log-rank test P = .005). Meanwhile, the NRS, VAS, Oswestry disability index, and quality of life scores at discharge or at the 12-week follow-up showed no significant difference. The rates of mild adverse events (AEs) were comparable between the groups. No severe AEs were reported, and none of the AEs were associated with the clinical trial. CONCLUSIONS T-MSAT combined with IKMT is a safe treatment that can effectively and quickly reduce initial pain in patients with LBP.
Collapse
Affiliation(s)
- Byung-Hak Park
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Jeong-Hun Han
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Jin-Hun Park
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Tae-Woon Min
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Hyun-Jun Lee
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Sook-Hyun Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Kyoung Sun Park
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| |
Collapse
|
11
|
Matias-Soto J, Pineda-Galan C, Martin-Sanchez AI, Gonzalez-Mesa JM, Aguayo-Alves A, Luque-Suarez A. Unveiling relevant emotions, cognitions, and behaviours from the viewpoint of people with chronic low back pain: A qualitative study with patient involvement. Musculoskelet Sci Pract 2024; 72:103123. [PMID: 38905971 DOI: 10.1016/j.msksp.2024.103123] [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] [Received: 03/19/2024] [Revised: 05/30/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE To gain insight into the emotions, cognitions, and behaviours experienced by people with chronic low back pain (CLBP) undergoing invasive treatment in a pain unit. DESIGN A cross-sectional qualitative study based on individual interviews. This study included patient involvement in its design and development. METHODS An interpretative phenomenological approach was adopted to understand the multidimensional experience of patients. The interview script was a translated, adapted, and expanded version of the one proposed by Cognitive and Functional Therapy. A mixed coding method was applied to structure the interviews. Three themes were created, with the three most frequently reported emotions, cognitions, and behaviours as subthemes. A patient with CLBP approved the initial protocol and the aim of the study. Subsequently, the patient contributed questions to the interview script, checked the coding process, and approved the final version of the manuscript. RESULTS Twenty-two patients undergoing epidural infiltrations in a pain unit were interviewed. (i)"Fears", (ii)"Frustration", and (iii)"Worry" were the three most commonly expressed emotions. Cognitions related to (i)"Pain predictability", (ii)"Pain description and perception", and (iii)"Pain interference/disability" were also widely reported. The theme "Behaviours" was composed of the following subthemes: (i)"Strategies for managing symptoms", (ii)"Social behaviours", and (iii)"Strategies for coping with daily tasks". Noteworthily, cognitions related to the (i)"Diagnosis", (ii)"Health system attention", and (iii)"Medical prescriptions" arose from questions provided by patient involvement. CONCLUSION Patients with CLBP expressed a wide variety of emotions, cognitions, and behaviours that must be considered by health professionals with the goal of providing the best patient-centred care.
Collapse
Affiliation(s)
- Javier Matias-Soto
- Universidad de Málaga, Andalucía Tech, Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Campus de Teatinos, Arquitecto Francisco Peñalosa, 3, 29071, Malaga, Spain; Chair of Health and Pain, University of Malaga, Malaga, Spain.
| | - Consolacion Pineda-Galan
- Universidad de Málaga, Andalucía Tech, Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Campus de Teatinos, Arquitecto Francisco Peñalosa, 3, 29071, Malaga, Spain; Chair of Health and Pain, University of Malaga, Malaga, Spain
| | | | | | - Adriane Aguayo-Alves
- Universidad de Málaga, Andalucía Tech, Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Campus de Teatinos, Arquitecto Francisco Peñalosa, 3, 29071, Malaga, Spain; Chair of Health and Pain, University of Malaga, Malaga, Spain
| | - Alejandro Luque-Suarez
- Universidad de Málaga, Andalucía Tech, Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Campus de Teatinos, Arquitecto Francisco Peñalosa, 3, 29071, Malaga, Spain; Chair of Health and Pain, University of Malaga, Malaga, Spain
| |
Collapse
|
12
|
Oxfeldt M, Tegner H, Björklund M, Christensen J. Danish short form Örebro Musculoskeletal Pain Screening Questionnaire: Translation, cross-cultural adaptation, and evaluation of measurement properties. J Back Musculoskelet Rehabil 2024:BMR230363. [PMID: 38968042 DOI: 10.3233/bmr-230363] [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: 07/07/2024]
Abstract
BACKGROUND Low back pain (LBP) is the leading cause of disability and an increasing sick leave in Denmark. Psychosocial risk factors have been linked to the development of LBP-related disability and work-absenteeism. The short form Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-sf) was developed to screen for psychosocial risk factors and assess the risk of long-term disability and work-absenteeism. OBJECTIVE To translate and cross-culturally adapt ÖMPSQ-sf into Danish and evaluate test-retest reliability with relative and absolute reliability and internal consistency in LBP-patients in a secondary setting. METHODS A six-step translation and cross-culturally adaptation process was used. Forty-four patients with subacute and chronic LBP were recruited at an outpatient clinic. RESULTS Test-retest reliability (n= 37) was found to be excellent (ICC2.1= 0.92), Internal Consistency (n= 44) was adequate (Cronbach's alpha = 0.72). Absolute reliability included Standard Error of Measurement (SEM = 3.97 points), 95% Limits of Agreement (95% LOA = 0.08, -15.90-15.74), and Smallest Detectable Change (SDC = 10.87 points). CONCLUSION The Danish ÖMPSQ-sf showed acceptable measurements properties in subacute and chronic LBP-patients. Further research is needed to assess other measurement properties of the ÖMPSQ-sf, in relation to validity, responsiveness, and the predictive ability before application in research or clinical practice.
Collapse
Affiliation(s)
- Martin Oxfeldt
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Heidi Tegner
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin Björklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
13
|
Bijker L, Scholten-Peeters GGM, Donker MH, Coppieters MW, Cuijpers P, Busink V, Poolman EY, de Wit LM. 'Leaving my comfort zone'. A qualitative study of physiotherapists' experiences blending an eHealth psychosocial intervention with face-to-face physiotherapy. Musculoskelet Sci Pract 2024; 73:103121. [PMID: 38936263 DOI: 10.1016/j.msksp.2024.103121] [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] [Received: 03/22/2024] [Revised: 05/21/2024] [Accepted: 06/10/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Many physiotherapists do not feel adequately equipped to address psychosocial risk factors in people with complex pain states. Hence, a biopsychosocial blended intervention (Back2Action) was developed to assist physiotherapists to manage people with persistent spinal pain and coexisting psychosocial risk factors associated with the development or maintenance of persistent pain. OBJECTIVE This study aimed to gain insight into the experiences of physiotherapists with this blended psychosocial intervention. DESIGN and methods: This was an interpretative qualitative study with a reflexive thematic analysis of semi-structured interviews with physiotherapists (N = 15) who delivered Back2Action. The interview started with the grand-tour question: "What was your experience in using Back2Action?" Physiotherapist were encouraged to provide examples, and follow-up questions were posed to ensure a deeper understanding could be reached. RESULTS Four themes were constructed: Physiotherapists became increasingly aware of (1) their own implicit expectations, biases and skills, and underlying treatment paradigms, and (2) the implicit expectations from their patients towards them. This led to (3) creating a deeper and stronger therapeutic alliance with the patient, but also (4) an understanding that implementation of a true biopsychosocial intervention - even if offered in a blended form - requires more practice, confidence and resources. CONCLUSIONS Back2Action is considered a valuable treatment to deliver a biopsychosocial intervention in primary care. Considering the high level of knowledge, skills and competency of the participating physiotherapists, the perceived barriers may be more difficult to overcome for more junior physiotherapists.
Collapse
Affiliation(s)
- L Bijker
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands; Amsterdam Public Health Research Institute, Department of Clinical Psychology, Vrije Universiteit Amsterdam, the Netherlands.
| | - G G M Scholten-Peeters
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands.
| | - M H Donker
- Department of Health Sciences, Vrije Universiteit Amsterdam, the Netherlands.
| | - M W Coppieters
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands; School of Health Sciences and Social Work, and Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia.
| | - P Cuijpers
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Vrije Universiteit Amsterdam, the Netherlands.
| | - V Busink
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - E Y Poolman
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands; Amsterdam Public Health Research Institute, Department of Clinical Psychology, Vrije Universiteit Amsterdam, the Netherlands.
| | - L M de Wit
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Vrije Universiteit Amsterdam, the Netherlands.
| |
Collapse
|
14
|
Prusynski RA, Gold LS, Rundell SD. Utilization and Potential Disparities in Access to Physical Therapy for Spine Pain in the Long-Term Care Population. Arch Phys Med Rehabil 2024:S0003-9993(24)01051-7. [PMID: 38866228 DOI: 10.1016/j.apmr.2024.05.032] [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: 05/02/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE To determine the frequency of physical therapy (PT) services and potential disparities in receiving PT among Medicare fee-for-service beneficiaries with a history of spine pain who live in long-term care (LTC) settings. DESIGN Secondary cross-sectional analysis of Medicare administrative data on beneficiaries with a history of spine pain from 2017-2019. We identified LTC residents using a validated algorithm, then identified and described PT episodes that occurred after the LTC index date. To identify potential disparities in access to PT services, we performed multivariable logistic regression to determine resident demographic, clinical, and community factors associated with receiving PT. SETTING Not applicable. PARTICIPANTS Medicare fee-for-service LTC residents aged ≥65 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Receiving PT services. RESULTS Of the 999,495 LTC residents with a history of spine pain, 49.6% received PT. Only 12.1% of PT episodes specifically treated spine pain. The odds of receiving PT were higher for residents with pain in multiple spine regions or neuropathic pain (OR, 1.27; 95% confidence interval CI, 1.26-1.29) and for residents with inpatient admissions (OR, 1.76; 95% CI, 1.75-1.78). Odds of receiving PT were lower for residents from minoritized racial and ethnic groups, and for residents with dementia (OR, 0.89; 95% CI, 0.88-0.90), depression (OR, 0.95; 95% CI, 0.94-0.96), or who lived in urban or more socioeconomically deprived areas. CONCLUSIONS Although nearly half of LTC residents with histories of spine pain received PT services, most PT was not for spine pain. There are potential disparities in access to PT for LTC residents from minoritized groups living in urban and more deprived areas. Further work should examine PT outcomes and remove barriers to PT for LTC residents with histories of spine pain.
Collapse
Affiliation(s)
- Rachel A Prusynski
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, Seattle WA; Department of Health Services and Population Health, University of Washington Seattle, WA.
| | - Laura S Gold
- Evidence and Research (CLEAR) Center for Musculoskeletal Disorders, the University of Washington Clinical Learning, Seattle, WA
| | - Sean D Rundell
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, Seattle WA; Evidence and Research (CLEAR) Center for Musculoskeletal Disorders, the University of Washington Clinical Learning, Seattle, WA
| |
Collapse
|
15
|
Marques YA, Custódio LA, Miyamoto GC, Nunes Cabral CM, de Toledo AM, Luiz Carregaro R. What are the costs of managing neck and low back pain in Brazil? Investigation of a ten-year period from the perspective of the Brazilian public health system. Expert Rev Pharmacoecon Outcomes Res 2024:1-10. [PMID: 38832499 DOI: 10.1080/14737167.2024.2364038] [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: 11/11/2023] [Accepted: 05/07/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Considering the prospects of increased prevalence and disability due to neck and low back pain, it is relevant to investigate the care processes adopted, to assist future public policies and decision-making for a better allocation of resources. Objective: the aim of this study was to estimate the costs arising from inpatient and outpatient care of individuals with Neck Pain (NP) and Low Back Pain (LBP) in Brazil, between 2010 and 2019. METHODS This is a cost-of-illness study from the perspective of the Brazilian public health system, based on health conditions with high prevalence (neck and low back pain). Data were presented descriptively using absolute and relative values. RESULTS Between 2010 and 2019, the health system spent more than $600 million (R$ 2.3 billion) to treat NP and LBP in adults, and LBP accounted for most of the expenses. Female had higher absolute expenses in inpatient care and in the outpatient system. CONCLUSION Our study showed that the costs with NP and LBP in Brazil were considerable. Female patients had higher outpatient costs and male patients had higher hospitalization costs. Healthcare expenses were concentrated for individuals between 34 and 63 years of age.
Collapse
Affiliation(s)
- Yara Andrade Marques
- Master Program in Rehabilitation Sciences, Universidade de Brasília (UnB), Brasília, Brazil
| | - Luciana Alves Custódio
- Master Program in Rehabilitation Sciences, Universidade de Brasília (UnB), Brasília, Brazil
- State Health Department of the Federal District (SES/DF), Brasília, Brazil
| | - Gisela Cristiane Miyamoto
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Cristina Maria Nunes Cabral
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | | | - Rodrigo Luiz Carregaro
- Master Program in Rehabilitation Sciences, Universidade de Brasília (UnB), Brasília, Brazil
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Natoli A, Jones MD, Long V, Mouatt B, Walker ED, Gibbs MT. How do people with chronic low back pain perceive specific and general exercise? A mixed methods survey. Pain Pract 2024; 24:739-748. [PMID: 38379359 DOI: 10.1111/papr.13354] [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: 02/22/2024]
Abstract
PURPOSE Exercise prescriptions for chronic low back pain (CLBP) often utilize reductionistic, trunk-focused exercise aimed at addressing proposed pain mechanisms. It is unknown if the use of these trunk-focused exercises imply beliefs to people with CLBP about the rationale for their use (e.g., etiology), even without concurrent biomedical narratives. This study aimed to explore people's perceptions of specific and general exercise without an accompanying narrative when experiencing CLBP. METHODS An anonymous online survey was distributed. Mixed methods were utilized for analysis. Six-point Likert scales categorized people's beliefs about individual exercises. Open-ended questions were used to gather further beliefs which were then coded into themes. RESULTS People with CLBP perceived specific exercise as more beneficial than general exercise. Eight themes and five subthemes were defined. A high volume of positive beliefs were centered around strengthening the low back and abdominal musculature, emphasizing the importance of correct technique. Negative beliefs were held against spinal flexion and external load. Both positive and negative beliefs were underpinned by spinal/pelvic stability being important as well as certain exercises being achievable or not. CONCLUSION This study demonstrated that people with CLBP consider specific exercises to be more beneficial than general exercises for CLBP. Specific exercises irrespective of an accompanying narrative can imply meaning about the intent of an exercise. Understanding this requires practitioners to be mindful when prescribing and communicating exercise.
Collapse
Affiliation(s)
- A Natoli
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - M D Jones
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - V Long
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - B Mouatt
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - E D Walker
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - M T Gibbs
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
17
|
Tefera YG, Gray S, Nielsen S, Gelaw A, Collie A. Impact of Prescription Medicines on Work-Related Outcomes in Workers with Musculoskeletal Disorders or Injuries: A Systematic Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2024; 34:398-414. [PMID: 37934329 PMCID: PMC11180015 DOI: 10.1007/s10926-023-10138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Medicines are often prescribed to workers with musculoskeletal disorders (MSDs) and injuries to relieve pain and facilitate their recovery and return to work. However, there is a growing concern that prescription medicines may have adverse effects on work function. This scoping review aimed to summarize the existing empirical evidence on prescription medicine use by workers with MSD or injury and its relationship with work-related outcomes. METHODS We identified studies through structured searching of MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Scopus, Web of Science and Cochrane library databases, and via searching of dissertations, theses, and grey literature databases. Studies that examined the association between prescription medicine and work-related outcomes in working age people with injury or MSDs, and were published in English after the year 2000 were eligible. RESULTS From the 4884 records identified, 65 studies were included for review. Back disorders and opioids were the most commonly studied musculoskeletal conditions and prescription medicines, respectively. Most studies showed a negative relationship between prescription medicines and work outcomes. Opioids, psychotropics and their combination were the most common medicines associated with adverse work outcomes. Opioid prescriptions with early initiation, long-term use, strong and/or high dose and extended pre- and post-operative use in workers' compensation setting were consistently associated with adverse work function. We found emerging but inconsistent evidence that skeletal muscle relaxants and non-steroidal anti-inflammatory drugs were associated with unfavorable work outcomes. CONCLUSION Opioids and other prescription medicines might be associated with adverse work outcomes. However, the evidence is conflicting and there were relatively fewer studies on non-opioid medicines. Further studies with more robust design are required to enable more definitive exploration of causal relationships and settle inconsistent evidence.
Collapse
Affiliation(s)
- Yonas Getaye Tefera
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Shannon Gray
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Australia
| | - Asmare Gelaw
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| |
Collapse
|
18
|
Wang XQ, Wang YL, Witchalls J, Han J, Zhang ZJ, Page P, Zhu Y, Stecco C, Lin JH, El-Ansary D, Ma QS, Qi Q, Oh JS, Zhang WM, Pranata A, Wan L, Li K, Ma M, Liao LR, Zhu YL, Guo JW, Chen PJ. Physical therapy for acute and sub-acute low back pain: A systematic review and expert consensus. Clin Rehabil 2024; 38:715-731. [PMID: 38317586 DOI: 10.1177/02692155241229398] [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: 02/07/2024]
Abstract
OBJECTIVE To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions. DATA SOURCES A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years. REVIEW METHODS Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts. RESULTS Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain. CONCLUSIONS The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.
Collapse
Affiliation(s)
- Xue-Qiang Wang
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yu-Ling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jeremy Witchalls
- Research Institute for Sports and Exercise, University of Canberra, Bruce, ACT, Australia
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Zhi-Jie Zhang
- Rehabilitation Therapy Center, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Luoyang, China
| | - Phillip Page
- Franciscan University, Franciscan Missionaries of Our Lady University, Baton Rouge, LA, USA
| | - Yi Zhu
- Department of Pain and Musculoskeletal Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Carla Stecco
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Jian-Hua Lin
- Department of Rehabilitation Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Doa El-Ansary
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Quan-Sheng Ma
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Qi Qi
- Department of Rehabilitation Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Jae-Seop Oh
- Department of Physical Therapy, INJE University, Gimhae, Republic of Korea
| | - Wei-Ming Zhang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Adrian Pranata
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Li Wan
- Rehabilitation Center, Jiangsu Province Hospital, Nanjing, Jiangsu, China
| | - Kui Li
- Department of the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ming Ma
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China
| | - Lin-Rong Liao
- Department of Rehabilitation, Yixing JORU Rehabilitation Hospital, Wuxi, China
| | - Yu-Lian Zhu
- Department of Rehabilitation, Huashan Hospital Fudan University, Shanghai, China
| | - Jing-Wei Guo
- Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Pei-Jie Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| |
Collapse
|
19
|
Lin H, Wang X, Feng Y, Liu X, Liu L, Zhu K, Shen J, Zhang P, Yu J, Yang T. Acupuncture Versus Oral Medications for Acute/Subacute Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis. Curr Pain Headache Rep 2024; 28:489-500. [PMID: 38190024 PMCID: PMC11156714 DOI: 10.1007/s11916-023-01201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE OF REVIEW Pharmacologic intervention do not always achieve benefits in the treatment of acute/subacute non-specific low back pain (NSLBP). We assessed efficacy and safety of acupuncture for acute/subacute NSLBP as alternative treatment. RECENT FINDINGS We searched PubMed, Web of Science, Embase, Cochrane Library, Scopus, Epistemonikos, CNKI, Wan Fang Database, VIP database, CBMLD, CSTJ, clinical trials, EUCTR, World WHO ICTRP, and ChiCTR for randomized controlled trials, cross-over studies, and cohort studies of NSLBP treated by acupuncture versus oral medication from inception to 23th April 2022. A total of 6 784 records were identified, and 14 studies were included 1 263 participants in this review. The results of the meta-analysis indicated that acupuncture therapy was slightly more effective than oral medication in improving pain (P < 0.00001, I2 = 92%, MD = -1.17, 95% CI [-1.61, -0.72]). According to the results of the meta-analysis, acupuncture therapy exhibited a significant advantage over oral medication with a substantial effect (P < 0.00001, I2 = 90%, SMD = -1.42, 95% CI [-2.22, -0.62]). Based on the results of the meta-analysis, acupuncture therapy was associated with a 12% improvement rate compared to oral medication in patients with acute/subacute NSLBP (P < 0.0001, I2 = 54%, RR = 1.11, 95% CI [1.05, 1.18]). Acupuncture is more effective and safer than oral medication in treating acute/subacute NSLBP. This systematic review is poised to offer valuable guidance to clinicians treating acute/subacute NSLBP and potentially benefit the afflicted patients. REGISTRATION This review was registered in PROSPERO ( http://www.crd.york.ac.uk/prospero ) with registration number CRD42021278346.
Collapse
Affiliation(s)
- Huize Lin
- Department of Acupuncture-Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xiang Wang
- Department of Acupuncture-Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yixuan Feng
- Department of Acupuncture-Moxibustion, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xiaoxu Liu
- Department of Acupuncture-Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Lanping Liu
- Department of Acupuncture-Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Kexin Zhu
- Department of Acupuncture-Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Jianghong Shen
- Department of Acupuncture-Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Pingping Zhang
- Department of Acupuncture-Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Jinna Yu
- Department of Acupuncture-Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Tao Yang
- Department of Acupuncture-Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| |
Collapse
|
20
|
Fu Y, Madsen SD, Shaheed CA, de Zoete A, Chiarotto A, Koes B. Moderators of treatment effect of non-steroidal anti-inflammatory drugs for patients with (sub) acute low back pain: Protocol for a systematic review with individual participant data meta-analysis. MethodsX 2024; 12:102713. [PMID: 38660043 PMCID: PMC11041908 DOI: 10.1016/j.mex.2024.102713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
A Cochrane review found that non-steroidal anti-inflammatory drugs (NSAIDs) are slightly more effective than placebo on acute and subacute low back pain (LBP) outcomes (pain intensity, disability, and global improvement). Our objectives are: (1) to assess the overall treatment effect of NSAIDs in adults with acute and subacute LBP; (2) to identify the moderation of baseline patients' characteristics on treatment effect. We will conduct a systematic search of RCTs on effectiveness of NSAIDs compared with placebo in adults with non-chronic LBP in Medline ALL, Embase, Cochrane Central Register of Controlled Trials*. We will screen the records after January 2020, and include eligible RCTs before January 2020 screened by the Cochrane review mentioned above. Our primary outcomes are pain intensity, disability, and health-related quality of life, secondary outcomes are adverse events. Our IPD dataset will consist of the information on each eligible trial characteristics and included variables according to a predefined coding scheme. We will assess risk-of-bias of included RCTs with the Cochrane Risk Of Bias (RoB)-2 assessment tool. We will perform power calculations with closed-form solutions and prioritize a one-stage approach for IPD-MA. For reporting the results, we will adhere to the PRISMA-IPD statement.
Collapse
Affiliation(s)
- Yanyan Fu
- Department of General Practice, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Simon Dyrløv Madsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- Chiropractic Knowledge Hub, Campusvej 55 5230, Odense, Denmark
| | - Christina Abdel Shaheed
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Annemarie de Zoete
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
- Research Unit of General Practice, Department of Public Health & Center for Muscle and Joint Health, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| |
Collapse
|
21
|
Pedersen JR, Strijkers R, Gerger H, Koes B, Chiarotto A. Clinical improvements due to specific effects and placebo effects in conservative interventions and changes observed with no treatment in randomized controlled trials of patients with chronic nonspecific low back pain: a systematic review and meta-analysis. Pain 2024; 165:1217-1232. [PMID: 38198235 DOI: 10.1097/j.pain.0000000000003151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/11/2023] [Indexed: 01/12/2024]
Abstract
ABSTRACT Little is known about the contribution of placebo effects and changes observed with no treatment in interventions for nonspecific low back pain (NSLBP). This systematic review assessed the proportions of the overall treatment effect that may be attributable to specific treatment effects, placebo effects, and changes observed with no treatment in randomized controlled trials (RCTs) in patients with NSLBP. Trials published before 2019 were identified from a published systematic review, and the search was updated in MEDLINE, Embase, and Cochrane Central for trials published between January 2019 and March 2023. Three-arm RCTs comparing the effects of experimental interventions vs placebo control vs no intervention reporting pain intensity, physical function, and/or health-related quality of life (HRQoL) were included. Sixteen RCTs with 1436 adults with chronic NSLBP testing conservative and mainly passive interventions were included. For pain intensity (16 studies), 33%, 18%, and 49% of the overall short-term treatment effect was attributable to specific treatment effects, placebo effects, and changes observed with no treatment, respectively. For physical function (11 studies) and HRQoL (6 studies), these proportions were 34%, 13%, and 53%, and 11%, 41%, and 48%, respectively. These results show that approximately half of the overall treatment effect of conservative and mainly passive interventions for patients with chronic NSLBP is attributable to changes observed with no treatment, rather than specific or placebo effects of treatments. However, the certainty of evidence was very low to low, suggesting that the true effects might be markedly different from the effect sizes underlying these estimates.
Collapse
Affiliation(s)
- Julie Rønne Pedersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rob Strijkers
- Department of General Practice, Erasmus MC, Rotterdam, the Netherlands
| | - Heike Gerger
- Department of General Practice, Erasmus MC, Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus MC, Rotterdam, the Netherlands
- Research Unit of General Practice, Department of Public Health and the Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | | |
Collapse
|
22
|
Kühn L, Rosen D, Reiter NL, Prill R, Choi KEA. Appropriateness of exercise therapy delivery in chronic low back pain management: cross-sectional online survey of physiotherapy practice in Germany. BMC Musculoskelet Disord 2024; 25:422. [PMID: 38811932 PMCID: PMC11137918 DOI: 10.1186/s12891-024-07505-y] [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: 09/08/2023] [Accepted: 05/07/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND In Germany, exercise therapy represents the most commonly prescribed physiotherapy service for non-specific, chronic low back pain (NSCLBP). So far, little is known about current practice patterns of German physiotherapists in delivering this intervention. Thus, the aim of this study was to investigate the appropriateness of exercise therapy delivered to NSCLBP patients in German physiotherapy care and to identify practitioner-related drivers of appropriate exercise delivery. METHODS We used a vignette-based, exploratory, cross-sectional, online-survey study design (76-items; data collection between May and July 2023). Eligible participants were required to hold a professional degree in physiotherapy and were required to be practicing in Germany. Access links to anonymous online surveys were spread via established German physiotherapy networks, educational platforms, social media, e-mail lists, and snowball sampling. Appropriateness of exercise therapy was calculated by an equally weighted total score (400 points) including scales on shared-decision-making, exercise dose selection, pain knowledge and self-management promotion. "Appropriate exercise delivery" was determined by a relative total score achievement of > 80%. "Partly appropriate exercise delivery" was determined by a relative total score achievement of 50-79%, and "inappropriate exercise delivery" by a score achievement of < 50%. Practitioner-related drivers of exercise appropriateness were calculated by bivariate and multiple linear regression analyses. RESULTS 11.9% (N = 35) of 298 physiotherapists' exercise delivery was considered "appropriate", 83.3% (N = 245) was "partly appropriate", and 4.8% (N = 14) was "inappropriate". In the final multiple regression model, most robust parameters positively influencing appropriate delivery of exercise therapy were increased scientific literacy (B = 10.540; 95% CI [0.837; 20.243]), increased average clinical assessment time (B = 0.461; 95% CI [0.134; 0.789]), increased self-perceived treatment competence (B = 7.180; 95% CI [3.058; 11.302], and short work experience (B = - 0.520; 95% CI [-0.959; - 0.081]). CONCLUSION Appropriate exercise delivery in NSCLBP management was achieved by only 11.9% of respondents. However, the vast majority of 95.2% of respondents was classified to deliver exercise therapy partly appropriate. Long work experience seemed to negatively affect appropriate exercise delivery. Positive influences were attributed to scientific literacy, the average clinical assessment time per patient as well as the perceived treatment competence in NSCLBP management. REGISTRATION Open science framework: https://doi.org/10.17605/OSF.IO/S76MF .
Collapse
Affiliation(s)
- Lukas Kühn
- Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, 15562, Neuruppin, Germany.
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816, Neuruppin, Germany.
| | - Diane Rosen
- Alice Salomon University of Applied Sciences, Alice-Salomon Platz 5, 12627, Berlin, Germany
| | - Nils Lennart Reiter
- Alice Salomon University of Applied Sciences, Alice-Salomon Platz 5, 12627, Berlin, Germany
- PhysioBib GbR, Johanniterstraße 26, 10961, Berlin, Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Hochstraße 29, 14770, Brandenburg an der Havel, Neuruppin, Germany
| | - Kyung-Eun Anna Choi
- Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, 15562, Neuruppin, Germany
- Health Services Research, Medical Imaging and Artificial Intelligence, Faculty of Medicine/Dentistry, Danube Private University, Steiner Landstraße 124, Krems-Stein, 3500, Austria
| |
Collapse
|
23
|
Corrêa LA, Mathieson S, Hancock M, Verhagen A, Nogueira LAC, Young A, Pate JW, French SD. Questionnaires assessing knowledge and beliefs about musculoskeletal conditions are potentially suitable for use, but further research is needed: a systematic review. J Clin Epidemiol 2024; 172:111398. [PMID: 38810841 DOI: 10.1016/j.jclinepi.2024.111398] [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: 01/04/2024] [Revised: 04/21/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES To evaluate the measurement properties of Patient-reported outcome measures (PROMs) for knowledge and/or beliefs about musculoskeletal conditions. STUDY DESIGN AND SETTING A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. This review was prospectively registered on PROSPERO - ID: CRD42022303111. Electronic databases, reference lists, forward citation tracking, and contact with experts were used to identify studies. Eligible studies were reports developing or assessing a measurement property of a PROM measuring musculoskeletal condition specific-knowledge and/or beliefs. We assessed the methodological quality and measurement properties of included studies. A modified Grading of Recommendations Assessment Development and Evaluation approach was used to rate the quality of evidence for each PROM. RESULTS The literature search was performed from inception to 11th September 2023. Sixty records were included, reporting 290 individual studies, and provided information on 25 PROMs. Five PROMs presented sufficient structural validity, three presented sufficient cross-cultural validity, ten presented sufficient reliability, three presented sufficient criterion validity, six presented sufficient hypothesis-testing, and four presented sufficient responsiveness. No PROM presented sufficient evidence for content validity, internal consistency, and measurement error. Based on the available evidence, no PROM was classified as suitable for use according to the COSMIN recommendations. Twenty-four PROMs are potentially suitable for use, and one PROM is not recommended for use. CONCLUSION No PROM designed to assess knowledge and/or beliefs about musculoskeletal conditions meets the COSMIN criteria of suitable for use. Most PROMs identified in this systematic review were considered as potentially suitable for use and need further high-quality research to assess their measurement properties.
Collapse
Affiliation(s)
- Leticia Amaral Corrêa
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Stephanie Mathieson
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark Hancock
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Arianne Verhagen
- University of Technology Sydney, Graduate School of Health, Physiotherapy, Ultimo, Australia
| | | | - Annie Young
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Joshua W Pate
- University of Technology Sydney, Graduate School of Health, Physiotherapy, Ultimo, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| |
Collapse
|
24
|
Gray SE, Tudtud B, Sheehan LR, Di Donato M. The Association of Physiotherapy Continuity of Care with Duration of Time Loss Among Compensated Australian Workers with Low Back Pain. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10209-8. [PMID: 38795245 DOI: 10.1007/s10926-024-10209-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE The aims of this study are to determine how continuous the care provided by physiotherapists to compensated workers with low back pain is, what factors are associated with physiotherapy continuity of care (CoC; treatment by the same provider), and what the association between physiotherapy CoC and duration of working time loss is. METHODS Workers' compensation claims and payments data from Victoria and South Australia were analysed. Continuity of care was measured with the usual provider continuity metric. Binary logistic regression examined factors associated with CoC. Cox regression models examined the association between working time loss and CoC. RESULTS Thirty-six percent of workers experienced complete CoC, 25.8% high CoC, 26.1% moderate CoC, and 11.7% low CoC. Odds of complete CoC decreased with increased service volume. With decreasing CoC, there was significantly longer duration of compensated time loss. CONCLUSION Higher CoC with a physiotherapist is associated with shorter compensated working time loss duration for Australian workers with low back pain.
Collapse
Affiliation(s)
- Shannon E Gray
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.
| | - Benedict Tudtud
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Luke R Sheehan
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Michael Di Donato
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| |
Collapse
|
25
|
Baroncini A, Maffulli N, Schäfer L, Manocchio N, Bossa M, Foti C, Klimuch A, Migliorini F. Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis. Sci Rep 2024; 14:11546. [PMID: 38773302 PMCID: PMC11109223 DOI: 10.1038/s41598-024-62276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.
Collapse
Affiliation(s)
- Alice Baroncini
- GSpine4, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milano, Italy
| | - Nicola Maffulli
- Department of Orthopaedics, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke on Trent, ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
| | - Luise Schäfer
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
| | - Nicola Manocchio
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Michela Bossa
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Calogero Foti
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Alexandra Klimuch
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| |
Collapse
|
26
|
Labanca L, Berti L, Tedeschi R, D'Auria L, Platano D, Benedetti MG. Effects of MLS Laser on pain, function, and disability in chronic non-specific low back pain: A double-blind placebo randomized-controlled trial. J Back Musculoskelet Rehabil 2024:BMR230383. [PMID: 38820011 DOI: 10.3233/bmr-230383] [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: 06/02/2024]
Abstract
BACKGROUND Among non-pharmacological interventions, Multiwave Locked System (MLS) Laser therapy has been used in patients with several musculoskeletal pathologies and in combination with other therapeutical interventions. The effects of sole MLS therapy on pain and function in patients with chronic non-specific low-back pain are unknown. OBJECTIVE The objective of this study was to investigate the effects of MLS Laser therapy on pain, function, and disability in patients with chronic non-specific low back pain in comparison to a placebo treatment group. METHODS Forty-five patients were randomized into two groups: the MLS Laser group and the Sham Laser group, undergoing 8 sessions of either a MLS Laser therapy or a Sham Laser therapy, respectively. At the beginning of the therapy (T0), at the end of the therapy (T1), and 1 month after the end of therapy (T2) patients were assessed for low back pain (by means of a VAS scale), function (by means of kinematic and electromyographic assessment of a forward bending movement) and self-reported disability (by means of the Roland-Morris and Oswestry Disability questionnaires). RESULTS There was a significant reduction of pain and disability in both groups at T1 and T2 in comparison with T0. At T2 patients in the MLS group showed a significantly lower pain in comparison with patients in the Sham group (VAS = 2.2 ± 2 vs. 3.6 ± 2.4; p< 0.05). No differences between the two groups were found for function and disability. CONCLUSION Both MLS Laser and Sham Laser therapies lead to a significant and comparable reduction in pain and disability in patients with chronic non-specific low back pain. However, one month after treatment, MLS Laser therapy has been found to be significantly more effective in reducing pain as compared to sham treatment.
Collapse
Affiliation(s)
- Luciana Labanca
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lisa Berti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lucia D'Auria
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Daniela Platano
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
27
|
Ampiah JA, Moffatt F, Diver CJ, Ampiah PK. 'Specialist before physiotherapist': physicians' and physiotherapists' beliefs and management of chronic low back pain in Ghana - A qualitative study. Disabil Rehabil 2024:1-11. [PMID: 38767467 DOI: 10.1080/09638288.2024.2356005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE This study provides an understanding of the chronic low back pain (CLBP) beliefs and management practices of physicians/doctors and physiotherapists in Ghana, and the mechanisms underlying their beliefs and practices. MATERIALS/METHODS Thirty-three individual semi-structured interviews, involving eighteen physio-therapists and fifteen physicians involved with CLBP management, were carried out. Interviews were audio recorded, transcribed, and analysed using Straussian grounded theory principles and critical realist philosophy. RESULTS Five categories were derived: The predominance of bio-medical/mechanical beliefs, maladaptive beliefs, maladaptive practices, limited involvement of physiotherapists and other healthcare professionals (HCPs) and evidence-based beliefs and practices. The predominant mechanisms underlying the HCPs beliefs and practices were: the healthcare environment (professional roles/identity hinged around paternalistic and biomedical care, fragmented CLBP management, limited physiotherapy/HCPs' knowledge) and sociocultural environment (sociocultural/patients' expectations of passive therapy and paternalism). CONCLUSION The CLBP beliefs and practices of HCPs involved with CLBP in Ghana is modelled around a professional identity that is largely hinged on paternalism and bio-medical/mechanical understandings. Lack of collaboration and sociocultural expectations also play a significant role. There is the need for a reconstitution of Ghanaian HCPs' CLBP beliefs and management approaches to align with evidenced-based approaches (e.g., imaging should not be universally prescribed, biopsychosocial and patient-centred care).
Collapse
Affiliation(s)
- Josephine Ahenkorah Ampiah
- Division of Physiotherapy, Sports Rehabilitation and Chiropractic, Institute of Health and Social Care, London South Bank University, London, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire J Diver
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paapa Kwesi Ampiah
- Department of Health Sciences, Division of Physiotherapy, College of Health, Medicine and Life Sciences, Brunel University, London, UK
| |
Collapse
|
28
|
Di Donato M, Gray S, Sheehan LR, Buchbinder R, Iles R, Collie A. How Much Physiotherapy, Chiropractic, and Osteopathy Care Do Compensated Australian Workers with Low Back Pain Receive? A Retrospective Cohort Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10202-1. [PMID: 38761339 DOI: 10.1007/s10926-024-10202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVES To identify the prevalence and frequency of physiotherapy, chiropractic, and/or osteopathy care in Australians with workers' compensation claims for low back pain (LBP). METHODS We included workers with accepted workers' compensation claims longer than 2 weeks from the Australian states of Victoria, Queensland, South Australia, and Western Australia. Workers were grouped by whether they attended physiotherapy, chiropractic, and/or osteopathy in the first 2 years of their claim. Descriptive statistics and logistic regression were used to describe differences between groups. Descriptive statistics and negative binomial regression were used to describe differences in the number of attendances in each group. RESULTS Most workers had at least one physical therapy attendance during the period of their claim (n = 23,619, 82.0%). Worker state, socioeconomic status, and remoteness were the largest contributing factors to likelihood of physical therapy attendance. Most workers only attended physiotherapy (n = 21,035, 89.1%, median of 13 times). Far fewer only attended chiropractic (n = 528, 2.2%, median of 8 times) or only osteopathy (n = 296, 1.3%, median of 10 times), while 1,750 (7.5%) attended for care with more than one type of physical therapy (median of 31 times). CONCLUSION Most Australian workers with workers' compensation time loss claims for LBP attend physiotherapy at least once during their claims. State of claim is the strongest predictor of which physical therapy profession they attend, possibly due to regional availability. Workers who see a physiotherapist have significantly more attendances. Future research should explore the relationship between these patterns of care and claimant outcomes, including work disability duration.
Collapse
Affiliation(s)
- Michael Di Donato
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3000, Australia.
| | - Shannon Gray
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3000, Australia
| | - Luke R Sheehan
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3000, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3000, Australia
| | - Ross Iles
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3000, Australia
| | - Alex Collie
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3000, Australia
| |
Collapse
|
29
|
Duarte ST, Moniz A, Costa D, Donato H, Heleno B, Aguiar P, Cruz EB. Low back pain management in primary healthcare: findings from a scoping review on models of care. BMJ Open 2024; 14:e079276. [PMID: 38754873 PMCID: PMC11097853 DOI: 10.1136/bmjopen-2023-079276] [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: 08/31/2023] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Models of care (MoCs) describe evidence-informed healthcare that should be delivered to patients. Several MoCs have been implemented for low back pain (LBP) to reduce evidence-to-practice gaps and increase the effectiveness and sustainability of healthcare services. OBJECTIVE To synthesise research evidence regarding core characteristics and key common elements of MoCs implemented in primary healthcare for the management of LBP. DESIGN Scoping review. DATA SOURCES Searches on MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, PEDro, Scopus, Web of Science and grey literature databases were conducted. ELIGIBILITY CRITERIA Eligible records included MoCs implemented for adult LBP patients in primary healthcare settings. DATA EXTRACTION AND SYNTHESIS Data extraction was carried out independently by two researchers and included a summary of the studies, the identification of the MoCs and respective key elements, concerning levels of care, settings, health professionals involved, type of care delivered and core components of the interventions. Findings were investigated through a descriptive qualitative content analysis using a deductive approach. RESULTS 29 studies reporting 11 MoCs were included. All MoCs were implemented in high-income countries and had clear objectives. Ten MoCs included a stratified care approach. The assessment of LBP patients typically occurred in primary healthcare while care delivery usually took place in community-based settings or outpatient clinics. Care provided by general practitioners and physiotherapists was reported in all MoCs. Education (n=10) and exercise (n=9) were the most common health interventions. However, intervention content, follow-ups and discharge criteria were not fully reported. CONCLUSIONS This study examines the features of MoCs for LBP, highlighting that research is in its early stages and stressing the need for better reporting to fill gaps in care delivery and implementation. This knowledge is crucial for researchers, clinicians and decision-makers in assessing the applicability and transferability of MoCs to primary healthcare settings.
Collapse
Affiliation(s)
- Susana Tinoco Duarte
- Comprehensive Health Research Centre, NOVA National School of Public Health - NOVA University Lisbon, Lisboa, Portugal
- Department of Physiotherapy, Polytechnic Institute of Setúbal - School of Health Care, Setúbal, Portugal
| | - Alexandre Moniz
- Department of Physiotherapy, Polytechnic Institute of Setúbal - School of Health Care, Setúbal, Portugal
- Comprehensive Health Research Centre, NOVA Medical School | Faculdade de Ciências Médicas, NMS | FCM - NOVA University Lisbon, Lisboa, Portugal
| | - Daniela Costa
- Department of Physiotherapy, Polytechnic Institute of Setúbal - School of Health Care, Setúbal, Portugal
- Department of Physiotherapy, Escola Superior de Saúde do Alcoitão, Alcabideche, Portugal
| | - Helena Donato
- Documentation and Scientific Information Service, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
- University of Coimbra Faculty of Medicine, Coimbra, Portugal
| | - Bruno Heleno
- Comprehensive Health Research Centre, NOVA Medical School | Faculdade de Ciências Médicas, NMS | FCM - NOVA University Lisbon, Lisboa, Portugal
| | - Pedro Aguiar
- Comprehensive Health Research Centre, NOVA National School of Public Health - NOVA University Lisbon, Lisboa, Portugal
| | - Eduardo B Cruz
- Department of Physiotherapy, Polytechnic Institute of Setúbal - School of Health Care, Setúbal, Portugal
- Comprehensive Health Research Centre, NOVA University Lisbon, Lisboa, Portugal
| |
Collapse
|
30
|
Kunow A, Freyer Martins Pereira J, Chenot JF. Extravertebral low back pain: a scoping review. BMC Musculoskelet Disord 2024; 25:363. [PMID: 38714994 PMCID: PMC11075250 DOI: 10.1186/s12891-024-07435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. METHODS A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. RESULTS The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. DISCUSSION Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. CONCLUSION The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.
Collapse
Affiliation(s)
- Anna Kunow
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany.
| | | | - Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany
| |
Collapse
|
31
|
Dobija L, Lechauve JB, Mbony-Irankunda D, Plan-Paquet A, Dupeyron A, Coudeyre E. Smartphone applications are used for self-management, telerehabilitation, evaluation and data collection in low back pain healthcare: a scoping review. F1000Res 2024; 11:1001. [PMID: 38846061 PMCID: PMC11153999 DOI: 10.12688/f1000research.123331.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/09/2024] Open
Abstract
Background Smartphone use has grown in providing healthcare for patients with low back pain (LBP), but the literature lacks an analysis of the use of smartphone apps. This scoping review aimed to identify current areas of smartphone apps use for managing LBP. We also aimed to evaluate the current status of the effectiveness or scientific validity of such use and determine perspectives for their potential development. Methods We searched PubMed, PEDro and Embase for articles published in English up to May 3 rd, 2021 that investigated smartphone use for LBP healthcare and their purpose. All types of study design were accepted. Studies concerning telemedicine or telerehabilitation but without use of a smartphone were not included. The same search strategy was performed by two researchers independently and a third researcher validated the synthesis of the included studies. Results We included 43 articles: randomised controlled trials (RCTs) (n=12), study protocols (n=6), reliability/validity studies (n=6), systematic reviews (n=7), cohort studies (n=4), qualitative studies (n=6), and case series (n=1). The purposes of the smartphone app were for 1) evaluation, 2) telerehabilitation, 3) self-management, and 4) data collection. Self-management was the most-studied use, showing promising results derived from moderate- to good-quality RCTs for patients with chronic LBP and patients after spinal surgery. Promising results exist regarding evaluation and data collection use and contradictory results regarding measurement use. Conclusions This scoping review revealed a notable interest in the scientific literatures regarding the use of smartphone apps for LBP patients. The identified purposes point to current scientific status and perspectives for further studies including RCTs and systematic reviews targeting specific usage.
Collapse
Affiliation(s)
- Lech Dobija
- UNH, INRAE, Université Clermont-Auvergne, Clermont-Ferrand, Puy de Dôme, 63000, France
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| | - Jean-Baptiste Lechauve
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| | - Didier Mbony-Irankunda
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| | - Anne Plan-Paquet
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| | - Arnaud Dupeyron
- Université Montpellier, Nimes, 30900, France
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Nimes, Nimes, 30900, France
| | - Emmanuel Coudeyre
- UNH, INRAE, Université Clermont-Auvergne, Clermont-Ferrand, Puy de Dôme, 63000, France
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Cébazat, Puy de Dôme, 63118, France
| |
Collapse
|
32
|
Rufa A, Brooks G, Adams KR, Dolphin M. The influence of low back pain-related attitudes and beliefs on the clinical decision making of physical therapists. J Man Manip Ther 2024:1-9. [PMID: 38700090 DOI: 10.1080/10669817.2024.2346973] [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: 12/10/2023] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The LBP-related attitudes and beliefs of clinicians may impact the experience of patients by influencing clinician decision-making and by shaping the attitudes, beliefs, and actions of patients. The purpose of this study was to identify the specific LBP-related attitudes and beliefs of US-based physical therapists and determine if those beliefs correlate with clinical decision-making. METHODS An electronic survey was sent to US-based physical therapists. Attitudes and beliefs were measured using the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain and Impairment Relationship Scale for Physiotherapists (PABS-PT). The survey also included 2 patient vignettes that collected information about clinical decision-making. RESULTS Complete survey responses were recorded from 420 physical therapists. Eleven of the 27 attitude and beliefs questions were answered in a more biomedically oriented way by at least 20% of respondents. Physical therapist low back pain-related attitudes and beliefs were associated with activity and management strategies for both vignettes in the expected direction. Higher scores on HC-PAIRS and PABS-BM were associated with more restrictive work and activity recommendations, lower-intensity exercise choices, biomechanical rationale for manual therapy and motor control exercises, pathoanatomical-focused education, and use of modalities. CONCLUSION Some physical therapists hold biomedically oriented beliefs about the connection between pain and physical activity. Clinician beliefs were associated with activity and work recommendations, and treatment choices. Physical therapists with more biomedically oriented beliefs were more likely to limit physical activity and work, and less likely to incorporate psychologically informed interventions.
Collapse
Affiliation(s)
- Adam Rufa
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Gary Brooks
- SUNY Upstate Medical University, Syracuse, NY, USA
| | | | | |
Collapse
|
33
|
He J, Tse MMY, Kwok TTO. The effectiveness, acceptability, and sustainability of non-pharmacological interventions for chronic pain management in older adults in mainland China: A systematic review. Geriatr Nurs 2024; 57:123-131. [PMID: 38640646 DOI: 10.1016/j.gerinurse.2024.04.008] [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: 12/22/2023] [Revised: 03/03/2024] [Accepted: 04/03/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES This systematic review aims to assess the effectiveness, acceptability, and sustainability of non-pharmacological pain management interventions for older adults in mainland China. MATERIALS AND METHODS Articles searching was conducted across six databases, including MEDLINE, PubMed, PsycINFO, Web of Science, China National Knowledge Infrastructure (CNKI), and WanFangdata. Quality appraisal was performed using the revised Cochrane risk of bias tool. RESULTS A total of 26 articles met the inclusion criteria, involving 2,197 participants with a mean age of 69.19 years. The participants' ages ranged from 63.85 to 81.75 years. The evaluated non-pharmacological interventions included psychotherapy, acupuncture, exercise, massage, neurotherapy, and multidisciplinary interventions. The overall changes in pain intensity varied from -5.19 to -0.65 on a numeric rating scale ranging from zero to ten. CONCLUSIONS Non-pharmacological interventions proved effective in alleviating pain intensity among older adults in mainland China. The findings suggest that mindfulness, exercise and pain education can be promoted as viable strategies for enhancing the well-being of the elderly population.
Collapse
Affiliation(s)
- Jiafan He
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong
| | - Mimi Mun Yee Tse
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong.
| | - Tyrone Tai On Kwok
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong
| |
Collapse
|
34
|
Farragher JB, Pranata A, Williams GP, El-Ansary D, Parry SM, Clark RA, Mentiplay B, Kasza J, Crofts S, Bryant AL. Neuromuscular Control and Resistance Training for People With Chronic Low Back Pain: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2024; 54:1-10. [PMID: 38497906 DOI: 10.2519/jospt.2024.12349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
OBJECTIVE: To determine if adding lumbar neuromuscular control retraining exercises to a 12-week program of strengthening exercises had greater effect for improving disability than 12 weeks of strengthening exercises alone in people with chronic low back pain (LBP). DESIGN: Single-center, participant- and assessor-blinded, comparative effectiveness randomized controlled trial. METHODS: Sixty-nine participants (31 females; 29 males; mean age: 46.5 years) with nonspecific chronic LBP were recruited for a 12-week program involving lumbar extension neuromuscular retraining in addition to resistance exercises (intervention) or 12 weeks of resistance exercises alone (control). The primary outcome measure was the Oswestry Disability Index. Secondary outcome measures included the Numeric Rating Scale, Tampa Scale for Kinesiophobia, Pain Self-Efficacy Questionnaire, and the International Physical Activity Questionnaire. Outcomes were measured at baseline, 6 weeks, and 12 weeks. RESULTS: Forty-three participants (22 control, 21 intervention) completed all outcome measures at 6 and 12 weeks. Fourteen participants were lost to follow-up, and 12 participants discontinued due to COVID-19 restrictions. Both groups demonstrated clinically important changes in disability, pain intensity, and kinesiophobia. The difference between groups with respect to disability was imprecise and not clinically meaningful (mean difference, -4.4; 95% CI: -10.2, 1.4) at 12 weeks. Differences in secondary outcomes at 6 or 12 weeks were also small with wide confidence intervals. CONCLUSIONS: Adding lumbar neuromuscular control retraining to a series of resistance exercises offered no additional benefit over resistance exercises alone over a 12-week period. J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 18 March 2024. doi:10.2519/jospt.2024.12349.
Collapse
|
35
|
Popovich JM, Cholewicki J, Reeves NP, DeStefano LA, Rowan JJ, Francisco TJ, Prokop LL, Zatkin MA, Lee AS, Sikorskii A, Pathak PK, Choi J, Radcliffe CJ, Ramadan A. The effects of osteopathic manipulative treatment on pain and disability in patients with chronic low back pain: a single-blinded randomized controlled trial. J Osteopath Med 2024; 124:219-230. [PMID: 38197301 DOI: 10.1515/jom-2022-0124] [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: 06/16/2022] [Accepted: 10/30/2023] [Indexed: 01/11/2024]
Abstract
CONTEXT The evidence for the efficacy of osteopathic manipulative treatment (OMT) in the management of low back pain (LBP) is considered weak by systematic reviews, because it is generally based on low-quality studies. Consequently, there is a need for more randomized controlled trials (RCTs) with a low risk of bias. OBJECTIVES The objective of this study is to evaluate the efficacy of an OMT intervention for reducing pain and disability in patients with chronic LBP. METHODS A single-blinded, crossover, RCT was conducted at a university-based health system. Participants were adults, 21-65 years old, with nonspecific LBP. Eligible participants (n=80) were randomized to two trial arms: an immediate OMT intervention group and a delayed OMT (waiting period) group. The intervention consisted of three to four OMT sessions over 4-6 weeks, after which the participants switched (crossed-over) groups. The primary clinical outcomes were average pain, current pain, Patient-Reported Outcomes Measurement Information System (PROMIS) 29 v1.0 pain interference and physical function, and modified Oswestry Disability Index (ODI). Secondary outcomes included the remaining PROMIS health domains and the Fear Avoidance Beliefs Questionnaire (FABQ). These measures were taken at baseline (T0), after one OMT session (T1), at the crossover point (T2), and at the end of the trial (T3). Due to the carryover effects of OMT intervention, only the outcomes obtained prior to T2 were evaluated utilizing mixed-effects models and after adjusting for baseline values. RESULTS Totals of 35 and 36 participants with chronic LBP were available for the analysis at T1 in the immediate OMT and waiting period groups, respectively, whereas 31 and 33 participants were available for the analysis at T2 in the immediate OMT and waiting period groups, respectively. After one session of OMT (T1), the analysis showed a significant reduction in the secondary outcomes of sleep disturbance and anxiety compared to the waiting period group. Following the entire intervention period (T2), the immediate OMT group demonstrated a significantly better average pain outcome. The effect size was a 0.8 standard deviation (SD), rendering the reduction in pain clinically significant. Further, the improvement in anxiety remained statistically significant. No study-related serious adverse events (AEs) were reported. CONCLUSIONS OMT intervention is safe and effective in reducing pain along with improving sleep and anxiety profiles in patients with chronic LBP.
Collapse
Affiliation(s)
- John M Popovich
- Center for Neuromusculoskeletal Clinical Research, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Jacek Cholewicki
- Center for Neuromusculoskeletal Clinical Research, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Lisa A DeStefano
- Center for Neuromusculoskeletal Clinical Research, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Jacob J Rowan
- Center for Neuromusculoskeletal Clinical Research, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Timothy J Francisco
- Center for Neuromusculoskeletal Clinical Research, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Lawrence L Prokop
- Center for Neuromusculoskeletal Clinical Research, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
- Department of Physical Medicine & Rehabilitation, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Mathew A Zatkin
- Center for Neuromusculoskeletal Clinical Research, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Angela S Lee
- Center for Neuromusculoskeletal Clinical Research, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Alla Sikorskii
- Department of Psychiatry Osteopathic Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Pramod K Pathak
- Department of Statistics and Probability, College of Natural Science, Michigan State University, East Lansing, MI, USA
| | - Jongeun Choi
- School of Mechanical Engineering, Yonsei University, Seoul, South Korea
| | - Clark J Radcliffe
- Department of Mechanical Engineering, College of Engineering, Michigan State University, East Lansing, MI, USA
| | - Ahmed Ramadan
- Department of Biomedical Engineering, College of Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
36
|
Kaple N, Phansopkar P. Comprehensive Physiotherapy Rehabilitation in a 25-Year-Old Female With Nonspecific Low Back Pain: A Case Report. Cureus 2024; 16:e60514. [PMID: 38883141 PMCID: PMC11180490 DOI: 10.7759/cureus.60514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
A prevalent musculoskeletal disorder known as nonspecific low back pain (NSLBP) is characterized by lumbar discomfort or pain that lacks a distinct, identifiable etiology. It is the main root of disability in all corners of the globe, affecting individuals across diverse age groups and occupations. NSLBP is often categorized as a multifactorial condition, encompassing a range of potential contributing factors such as poor posture, sedentary lifestyle, muscle imbalances, and psychosocial elements. According to current standards, there is a good prognosis for acute nonspecific back pain, although this prognosis is mostly reliant on return to function. Various treatment strategies are available, totally reliant upon the underlying cause of the discomfort. This case report presents the combination of traditional therapy and William's flexion exercises in a 25-year-old female nursing student who presented with complaints of low back pain (LBP) for the last three months. This study investigates the effect of William's flexion exercises in nonspecific low back pain to manage pain and range of motion (ROM), and improve the overall quality of life, which was evaluated using the visual analog scale (VAS), modified Schober's test, pressure biofeedback unit, and modified Oswestry disability questionnaire. The patient received an enhanced physiotherapy program that increased the flexibility and range of motion in the lumbar extensor, hip flexor, and hamstring muscles. The outcome measure shows notable gains after the therapeutic interventions.
Collapse
Affiliation(s)
- Nikita Kaple
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratik Phansopkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
37
|
Zhou T, Salman D, McGregor AH. Recent clinical practice guidelines for the management of low back pain: a global comparison. BMC Musculoskelet Disord 2024; 25:344. [PMID: 38693474 PMCID: PMC11061926 DOI: 10.1186/s12891-024-07468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is a significant health problem worldwide, with a lifetime prevalence of 84% in the general adult population. To rationalise the management of LBP, clinical practice guidelines (CPGs) have been issued in various countries around the world. This study aims to identify and compare the recommendations of recent CPGs for the management of LBP across the world. METHODS MEDLINE, EMBASE, CINAHL, PEDro, and major guideline databases were searched from 2017 to 2022 to identify CPGs. CPGs focusing on information regarding the management and/or treatment of non-specific LBP were considered eligible. The quality of included guidelines was evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. RESULTS Our analysis identified a total of 22 CPGs that met the inclusion criteria, and were of middle and high methodological quality as assessed by the AGREE II tool. The guidelines exhibited heterogeneity in their recommendations, particularly in the approach to different stages of LBP. For acute LBP, the guidelines recommended the use of non-steroidal anti-inflammatory drugs (NSAIDs), therapeutic exercise, staying active, and spinal manipulation. For subacute LBP, the guidelines recommended the use of NSAIDs, therapeutic exercise, staying active, and spinal manipulation. For chronic LBP, the guidelines recommended therapeutic exercise, the use of NSAIDs, spinal manipulation, and acupuncture. CONCLUSIONS Current CPGs provide recommendations for almost all major aspects of the management of LBP, but there is marked heterogeneity between them. Some recommendations lack clarity and overlap with other treatments within the guidelines.
Collapse
Affiliation(s)
- Tianyu Zhou
- MSk lab, Department of Surgery & Cancer, Imperial College London, London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, W12 0BZ, UK.
| | - David Salman
- MSk lab, Department of Surgery & Cancer, Imperial College London, London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, W12 0BZ, UK
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Alison H McGregor
- MSk lab, Department of Surgery & Cancer, Imperial College London, London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, W12 0BZ, UK
| |
Collapse
|
38
|
Kim TK, Gil HY. Effects of Paraspinal Intramuscular Injection of Atelocollagen in Patients with Chronic Low Back Pain: A Retrospective Observational Study. J Clin Med 2024; 13:2607. [PMID: 38731135 PMCID: PMC11084233 DOI: 10.3390/jcm13092607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/21/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Atelocollagen is used for soft tissue repair and reconstruction by replacing defective or damaged muscles, membranes, ligaments, and tendons. This study aimed to evaluate the clinical efficacy and safety of additional paraspinal intramuscular injection of atelocollagen on lumbar epidural steroid injection for reducing pain and improving functional capacity of patients with chronic low back pain (CLBP). Methods: We retrospectively enrolled 608 consecutive patients with CLBP who received lumbar epidural steroid injection with or without additional paraspinal intramuscular injection of atelocollagen. The Numerical Rating Scale and the Oswestry Disability Index were used to assess pain and functional capacity, respectively, before the procedure, and three months after the injection. Also, we analyzed the relationship between the additional paraspinal intramuscular injection of atelocollagen and the success rate. Results: Both Numerical Rating Scale and the Oswestry Disability Index scores were significantly reduced in both groups at three months after injection. However, there was a significant difference between the two groups. Furthermore, the success rate was significantly higher in the additional paraspinal intramuscular injection of atelocollagen group. Conclusions: This study's results showed that additional paraspinal intramuscular injection of atelocollagen on lumbar epidural steroid injection reduced pain and improved functional capacity for patients with CLBP. Therefore, the paraspinal intramuscular injection of atelocollagen may be a promising option for the treatment of patients with CLBP.
Collapse
Affiliation(s)
- Tae Kwang Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea;
| | - Ho Young Gil
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi 39371, Republic of Korea
| |
Collapse
|
39
|
Hung KKC, Lam RPK, Lee HKH, Choi YF, Tenney J, Zuo Z, Chong MKC, Hui TSI, Wong TK, Yiu TY, Chan SY, Mok CPY, Leung LY, Mak WK, Sun DTF, Cheng CH, Graham CA. Comparison of diclofenac with tramadol, tizanidine or placebo in the treatment of acute low back pain and sciatica: multi-center randomized controlled trial. Postgrad Med J 2024:qgae052. [PMID: 38679808 DOI: 10.1093/postmj/qgae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/16/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Low back pain (LBP) is a leading cause of disability worldwide and has posed numerous health and socioeconomic challenges. This study compared whether nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with tramadol, tizanidine or placebo would be the best treatment regime to improve the Roland Morris Disability Questionnaire (RMDQ) scores at 1 week. METHODS This was a multi-center, double-blind, randomized, and placebo-controlled trial including adult patients with acute LBP and sciatica in three emergency departments in Hong Kong. Patients were randomized to the receive tramadol 50 mg, tizanidine 2 mg, or placebo every 6 hours for 2 weeks in a 1:1:1 ratio. The RMDQ and other secondary outcomes were measured at baseline, Day 2, 7, 14, 21, and 28. Data were analyzed on an intention to treat basis. Crude and adjusted mean differences in the changes of RMDQ and NRS scores from baseline to Day 7 between tizanidine/tramadol and placebo were determined with 95% confidence intervals. RESULTS Two hundred and ninety-one patients were analyzed with the mean age of 47.4 years and 57.7% were male. The primary outcome of mean difference in RMDQs on Day 7 (compared with baseline) was non-significant for tizanidine compared with placebo (adjusted mean difference - 0.56, 95% CI -2.48 to 1.37) and tramadol compared with placebo (adjusted mean difference - 0.85, 95% CI -2.80 to 1.10). Only 23.7% were fully compliant to the treatment allocated. Complier Average Causal Effect analysis also showed no difference in the primary outcome for the tizanidine and tramadol versus placebo. CONCLUSION Among patients with acute LBP and sciatica presenting to the ED, adding tramadol or tizanidine to diclofenac did not improve functional recovery.
Collapse
Affiliation(s)
- Kevin K C Hung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
- Accident & Emergency Department, Prince of Wales Hospital, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Rex P K Lam
- Department of Emergency Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, G06, G/F, University of Hong Kong the Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China, Hong Kong
| | - Herman K H Lee
- Accident & Emergency Department, United Christian Hospital, 130 Hip Wo St, Kwun Tong, Hong Kong SAR, Hong Kong
| | - Yu Fai Choi
- Accident & Emergency Department, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, Hong Kong
| | - Justin Tenney
- School of Pharmacy, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building Area 39, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, Hong Kong
- Pharmacy Department, Canberra Hospital, Yamba Drive Garran ACT 2605, Canberra, Australia
| | - Zhong Zuo
- School of Pharmacy, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building Area 39, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, Hong Kong
| | - Marc K C Chong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Theresa S I Hui
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Tak Kan Wong
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Tsz Ying Yiu
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Suet Yi Chan
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Catherine P Y Mok
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Wai Kit Mak
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - David T F Sun
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Chi Hung Cheng
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
- Accident & Emergency Department, Prince of Wales Hospital, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
- Accident & Emergency Department, Prince of Wales Hospital, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, Hong Kong
| |
Collapse
|
40
|
Hansford HJ, Jones MD, Cashin AG, Ostelo RW, Chiarotto A, Williams SA, Sharma S, Rose JM, Devonshire JJ, Ferraro MC, Wewege MA, McAuley JH. The smallest worthwhile effect on pain intensity of exercise therapy for people with chronic low back pain: a discrete choice experiment study. J Orthop Sports Phys Ther 2024:1-26. [PMID: 38630543 DOI: 10.2519/jospt.2024.12279] [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: 04/19/2024]
Abstract
OBJECTIVE: To identify the smallest worthwhile effect (SWE) of exercise therapy for people with non-specific chronic low back pain (CLBP). DESIGN: Discrete choice experiment. METHODS: The SWE was estimated as the lowest reduction in pain that participants would consider exercising worthwhile, compared to not exercising i.e., effects due to natural history and other components (e.g., regression to the mean). We recruited English-speaking adults in Australia with non-specific CLBP to our online survey via email obtained from a registry of previous participants and advertisements on social media. We used discrete choice experiment to estimate the SWE of exercise compared to no exercise for pain intensity. We analysed the discrete choice experiment using a mixed logit model, and mitigated hypothetical bias through certainty calibration, with sensitivity analyses performed with different certainty calibration thresholds. RESULTS: Two-hundred and thirteen participants completed the survey. The mean age (±SD) was 50.7±16.5, median (IQR) pain duration 10 years (5-20), and mean pain intensity (±SD) was 5.8±2.3 on a 0-10 numerical rating scale. For people with CLBP the SWE of exercise was a between-group reduction in pain of 20%, compared to no exercise. In the sensitivity analyses, the SWE varied with different levels of certainty calibration; from 0% without certainty calibration to 60% with more extreme certainty calibration. CONCLUSION: This patient-informed threshold of clinical importance could guide the interpretation of findings from randomised trials and meta-analyses of exercise therapy compared to no exercise.
Collapse
Affiliation(s)
- Harrison J Hansford
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Raymond Wjg Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, location Vrije Universiteit, Amsterdam Movement Sciences, The Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Sam A Williams
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - John M Rose
- Neil Smith Research Chair in Sustainable Transport Futures, Institute of Transport and Logistics Studies, The University of Sydney Business School, Sydney, New South Wales, 2006, Australia
| | - Jack J Devonshire
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Michael C Ferraro
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Michael A Wewege
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| |
Collapse
|
41
|
Wilson AT, Pinette J, Lyons K, Hanney WJ. Exercise induced hypoalgesia during different intensities of a dynamic resistance exercise: A randomized controlled trial. PLoS One 2024; 19:e0299481. [PMID: 38625975 PMCID: PMC11020855 DOI: 10.1371/journal.pone.0299481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/09/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Exercise produces an immediate lessening of pain sensitivity (Exercise-Induced Hypoalgesia (EIH)) in healthy individuals at local and distant sites, possibly through a shared mechanism with conditioned pain modulation (CPM). Dynamic resistance exercise is a recommended type of exercise to reduce pain, yet limited research has examined the effects of intensity on EIH during this type of exercise. Therefore, the primary purpose of this study is to compare changes in PPT at a local and distant site during a leg extension exercise at a high intensity, a low intensity, or a quiet rest condition. A secondary purpose is to examine if CPM changes after each intervention. The final purpose is to examine if baseline pain sensitivity measures are correlated with response to each intervention. METHODS In a randomized controlled trial of 60 healthy participants, participants completed baseline pain sensitivity testing (heat pain threshold, temporal summation, a cold pressor test as measure of CPM) and were randomly assigned to complete a knee extension exercise at: 1) high intensity (75% of a 1 Repetition Maximum (RM), 2) low intensity (30% 1RM), or 3) Quiet Rest. PPT was measured between each set at a local (quadriceps) and distant (trapezius) site during the intervention. CPM was then repeated after the intervention. To test the first purpose of the study, a three-way ANOVA examined for time x site x intervention interaction effects. To examine for changes in CPM by group, a mixed-model ANOVA was performed. Finally, a Pearson Correlation examined the association between baseline pain sensitivity and response to each intervention. RESULTS Time x site x intervention interaction effects were not significant (F(5.3, 150.97) = 0.87, p = 0.51, partial eta2 = 0.03). CPM did not significantly change after the interventions (time x intervention F(1,38) = 0.81, p = 0.37, partial eta2 = 0.02. EIH effects at the quadriceps displayed a significant, positive moderate association with baseline HPT applied over the trapezius (r = 0.61, p<0.01) and TS (r = 0.46, p = 0.04). DISCUSSION In healthy participants, PPT and CPM did not significantly differ after a leg extension exercise performed at a high intensity, low intensity, or quiet rest condition. It is possible pre-intervention CPM testing with a noxious stimuli may have impaired inhibitory effects frequently observed during exercise but future research would need to examine this hypothesis.
Collapse
Affiliation(s)
- Abigail T. Wilson
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, United States of America
- Musculoskeletal Research Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, United States of America
| | - John Pinette
- Musculoskeletal Research Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, United States of America
| | - Kaitlyn Lyons
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, United States of America
- Musculoskeletal Research Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, United States of America
| | - William J. Hanney
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, United States of America
- Musculoskeletal Research Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida, United States of America
| |
Collapse
|
42
|
Lemmers GPG, Melis RJF, Hak R, de Snoo EK, Pagen S, Westert GP, Staal JB, van der Wees PJ. The association of physical activity and sedentary behaviour with low back pain disability trajectories: A prospective cohort study. Musculoskelet Sci Pract 2024; 72:102954. [PMID: 38691981 DOI: 10.1016/j.msksp.2024.102954] [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] [Received: 11/13/2023] [Revised: 03/22/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Multiple factors influence the recovery process of low back pain (LBP). The identification and increased knowledge of risk factors might contribute to a better understanding of the course of LBP. OBJECTIVES To investigate the association of habitual physical activity (PA) and sedentary behaviour (SB), measured at baseline, with disability trajectories in adults with LBP. METHODS A prospective cohort study where habitual PA levels were measured using the Short QUestionnaire to ASsess Health enhancing physical activity (SQUASH), SB was calculated as average sedentary hours per day, and LBP disability using the Oswestry Disability Index (ODI). Participants completed the questionnaires at one and a half, three, six, and twelve months. Linear mixed models were estimated to describe the association of habitual PA levels SB measured at baseline with disability trajectories. Other predictors were gender, education level, age, pain, number of previous episodes of LBP, and duration of LBP. RESULTS Habitual SB measured at baseline in adults (n = 347) with LBP were not associated with disability trajectories. For PA, participants with one metabolic equivalent of task (MET) hour per day above average recovered 0.04 [95% CI 0.004 to 0.076] points on the ODI per month faster than participants with an average amount of MET hours per day. CONCLUSIONS Habitual SB was not associated with LBP disability trajectories over a one-year follow-up. High levels of habitual PA at baseline were associated with improved recovery in LBP disability trajectory, but the finding is not clinically relevant.
Collapse
Affiliation(s)
- Gijs Petrus Gerardus Lemmers
- Radboud University Medical Center, IQ Health, Kapittelweg 54, 6525 EP, Nijmegen, the Netherlands; Dutch Healthcare Authority, Newtonlaan 1-41, 3584 BX, Utrecht, the Netherlands.
| | - René J F Melis
- Radboud University Medical Center, Department of Geriatric Medicine, Reinier Postlaan 4, 6525 EX, Nijmegen, the Netherlands.
| | - Robin Hak
- Fysius Back Experts, Bedrijvenweg 7, 7442 CX, Nijverdal, the Netherlands.
| | | | - Sophie Pagen
- TheFysioclub, Vicaris van der Asdonckstraat 55, 5421 VB, Gemert, the Netherlands.
| | - Gerard Pieter Westert
- Radboud University Medical Center, IQ Health, Kapittelweg 54, 6525 EP, Nijmegen, the Netherlands.
| | - Jacobus Bart Staal
- Radboud University Medical Center, IQ Health, Kapittelweg 54, 6525 EP, Nijmegen, the Netherlands; Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN, Nijmegen, the Netherlands.
| | - Philip Jan van der Wees
- Radboud University Medical Center, IQ Health, Kapittelweg 54, 6525 EP, Nijmegen, the Netherlands.
| |
Collapse
|
43
|
Esposto M, Pellicciari L, Cecchetto S, Chiarotto A, Testa M, Turolla A, Polli A. Italian versions of the Neurophysiology of Pain Questionnaire (NPQ): psychometric properties and an investigation on the understanding of pain neurophysiology in physical therapists. Musculoskelet Sci Pract 2024; 72:102957. [PMID: 38642475 DOI: 10.1016/j.msksp.2024.102957] [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] [Received: 10/15/2023] [Revised: 02/29/2024] [Accepted: 04/09/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES The Neurophysiology of Pain Questionnaire (NPQ) is widely used to assess pain knowledge among clinicians and patients with pain, but an Italian version is not available. This study aimed to translate and cross-culturally adapt the NPQ into Italian, to test its psychometric properties, to assess the knowledge of Italian physical therapists (PTs) on pain, and to evaluate which characteristics are associated with pain knowledge. METHODS The NPQ was translated into Italian, integrated with some additional questions (IT-NPQ-New), and sent by email via the Italian Association of Physiotherapy newsletter. Rasch analysis (RA) was used to test the psychometric properties of the Italian versions. Multivariable regression analyses were used to check for associations between participants' characteristics and their NPQ scores. RESULTS A sample of 753 PTs completed the survey. RA of the NPQ-19 and IT-NPQ-New revealed that 10 (IT-NPQ-10) and 18 (IT-NPQ-18) items fit the model. Both questionnaires showed good psychometric properties. The overall median score among Italian PTs was 6.0 [5.0-7.0] and 11.0 [9.0-13.0] points for the IT-NPQ-10 and the IT-NPQ-18, respectively. These scores were statistically different among groups according to gender, age, years of professional activity, post-graduate specialization and days attended of targeted pain courses, with the latter being the most influential variable. CONCLUSIONS Italian PTs now dispose of two tools to assess their basic knowledge related to pain science. Our study also showed that pain knowledge among Italian PTs needs improvement, especially considering recent biopsychosocial approaches to pain.
Collapse
Affiliation(s)
- Massimo Esposto
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, C/o Cardarelli Hospital, C/da Tappino, 86100, Campobasso, Italy
| | | | - Simone Cecchetto
- Health Professional and Rehabilitation Service APSS Trento, Trento, Italy
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy; Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Polli
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology, and Anatomy, Vrije Universiteit Brussel (VUB), Centre for Environment & Health, Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Research Foundation - Flanders (FWO), Belgium
| |
Collapse
|
44
|
McGargill S, Sein M, Sibille KT, Thompson Z, Brownstein M, Vincent HK. Considerations beyond spine pain: do different co-occurring lower body joint pains differentially influence physical function and quality of life ratings? BMC Musculoskelet Disord 2024; 25:269. [PMID: 38589851 PMCID: PMC11000411 DOI: 10.1186/s12891-024-07393-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Patients seeking medical care for back pain often have coexisting painful joints and the effects of different combinations and number of coexisting pain sites (hip, knee, foot/ankle) to back pain on physical function domains and quality of life rating are not yet established. The purpose of this study was to determine the differences in functional outcomes and QOL among individuals with back pain who have concurrent additional pain sites or no pain sites. METHODS Data from the Osteoarthritis Initiative (OAI) cohort were used for this cross-sectional analysis. Men and women aged 45-79 years with back pain were binned into nine groups by presence or not of coexisting hip, knee, ankle/foot pain and combinations of these sites (N = 1,642). Healthy controls reported no joint pain. Main outcomes included Knee Injury and Osteoarthritis Outcome score (KOOS; quality of life and function-sports-and-recreation), Western Ontario McMaster Universities Osteoarthritis Index (WOMAC; Activities of Daily Living, Pain), Medical Outcomes Short Form-12 (SF-12) Physical Component score, and self-reported function in last 7-30 days (lifting 25-pound objects, housework). 20-m and 400-m walk times and gait speed and repeated chair rise test times were collected. RESULTS Compared to back pain alone, pain at all five sites was associated with 39%-86% worse KOOS, WOMAC, and SF-12 scores (p < .0001). Back-Hip and Back-Knee did not produce worse scores than Back pain alone, but Back-Hip-Knee and Back-Knee-Ankle/Foot did. The 20-m, 400-m walk, and repeated chair times were worse among individuals with pain at all five sites. Additional hip and knee sites to back pain, but not ankle/foot, worsened performance-based walk times and chair rise scores. CONCLUSIONS The number and type of coexistent lower body musculoskeletal pain among patients with back pain may be associated with perceived and performance-based assessments. Management plans that efficiently simultaneously address back and additional coexistent pain sites may maximize treatment functional benefits, address patient functional goals in life and mitigate disability.
Collapse
Affiliation(s)
- Shawn McGargill
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, PO Box 112730, Gainesville, FL, 32611, USA
| | - Michael Sein
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, PO Box 112730, Gainesville, FL, 32611, USA
| | - Kimberly T Sibille
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, PO Box 112730, Gainesville, FL, 32611, USA
| | - Zane Thompson
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, PO Box 112730, Gainesville, FL, 32611, USA
| | - Michael Brownstein
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, PO Box 112730, Gainesville, FL, 32611, USA
| | - Heather K Vincent
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, PO Box 112730, Gainesville, FL, 32611, USA.
| |
Collapse
|
45
|
Li X, Zhai G, Zhang H, Li X, Wu M, Zhang S, Cui J, Tang Z, Hu Z. Clinical efficacy of acupuncture therapy combined with core muscle exercises in treating patients with chronic nonspecific low back pain: a systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne) 2024; 11:1372748. [PMID: 38638928 PMCID: PMC11024316 DOI: 10.3389/fmed.2024.1372748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction This meta-analysis aimed to determine the clinical efficacy of acupuncture combined with core muscle exercises on pain and functional status in patients with chronic nonspecific low back pain. Methods This study followed the Preferred Reporting Items for Systematic Reviews and meta-analysis criteria for systematic reviews and meta-analyses. Randomized controlled trials published till November 2023 were searched in PubMed, Web of Science, Cochrane, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature, and Wanfang databases. The search strategy was related to disease type, intervention, and control measures and was structured around the search terms "low back pain," "acupuncture therapy," and "exercise." Two reviewers applied inclusion and exclusion criteria. Sensitivity and fixed effects analyses were performed to determine the primary outcomes. Results We included 11 randomized controlled trials (n = 727) on acupuncture combined with core muscle exercises in patients with chronic nonspecific low back pain. Compared with controls, clinical efficacy was significant, with improvements in pain scores (visual analog pain scale and numerical rating scale) and Oswestry Disability Index in the intervention group. Discussion Acupuncture therapy combined with core muscle exercises improved pain and functional status in patients with chronic nonspecific low back pain, with favorable clinical outcomes compared with single-core muscle training. Multicenter large-sample trials are required to obtain more reliable conclusions.
Collapse
Affiliation(s)
- Xia Li
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guohua Zhai
- Fenglin Community Health Service Centre, Shanghai, China
| | - Hongkai Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuefei Li
- Longhua Clinical Medical College of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mingqi Wu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sidi Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiawen Cui
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhanying Tang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Jinshan District Hospital of Integrated Chinese and Western Medicine, Shanghai, China
| | - Zhijun Hu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
46
|
Hubeishy MH, Rossen CB, Dannapfel P, Thomas K, Jensen TS, Maribo T, Rolving N. Developing a low back pain guideline implementation programme in collaboration with physiotherapists and chiropractors using the Behaviour Change Wheel: a theory-driven design study. Implement Sci Commun 2024; 5:33. [PMID: 38570830 PMCID: PMC10993475 DOI: 10.1186/s43058-024-00568-x] [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: 01/04/2024] [Accepted: 03/09/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Low back pain is still the leading cause of disability and societal burden, with 619 million prevalent cases worldwide in 2020. Most countries produce clinical guidelines to support healthcare professionals in evidence-based care regarding low back pain. However, several studies have identified relatively poor uptake of guidelines. Tailored strategies to facilitate the implementation of guidelines have been argued to increase uptake. This study aimed to develop a contextually tailored implementation programme to enhance evidence-based low back pain care among Danish physiotherapists and chiropractors in primary care. METHODS A theory-driven implementation programme development study was conducted using the Behaviour Change Wheel, with high healthcare professional involvement. Data collection included four workshops with seven physiotherapists and six chiropractors from primary care clinics. The development process consisted of [1] establishing a theoretical frame, [2] involving participants, [3] understanding the behaviour, [4] designing the implementation programme, and [5] final implementation programme. RESULTS The target behaviours selected (guideline recommendations) for the implementation programme were (i) screening of psychosocial risk factors and (ii) offering patient education. The barriers and facilitators for the selected behaviours were described and linked to intervention functions and behavioural techniques. Finally, the implementation programme comprised five strategies: webinars, e-learning videos, communication exercises, peer learning, and group dialogue meetings. In addition, the programme consisted of implementation support: champions, a physical material folder, a weekly email reminder, a specially designed website and a visit from an implementation consultant. An essential element of the overall programme was that it was designed as a step-by-step implementation process consisting of 16 h of education and training distributed over 16 weeks. CONCLUSIONS A programme for implementing low back pain guideline recommendations was developed based on behaviour change theory and four co-design workshops involving healthcare professionals to overcome the contextually identified barriers. A theory-driven approach involving healthcare professionals was useful in identifying relevant target behaviours and tailoring the programme to consider contextual barriers and facilitators for implementation. The effectiveness of the final implementation programme will be evaluated in the project's next phase. TRIAL REGISTRATION Central Denmark Region, Registered November 11, 2021, act no. 1-16-02-93-19.
Collapse
Affiliation(s)
- Maja Husted Hubeishy
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Hospital in Central Denmark Region, Falkevej 1-3, 8600, Silkeborg, Denmark.
- Department of Public Health, Aarhus University, Aarhus, Denmark.
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.
| | - Camilla Blach Rossen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Hospital in Central Denmark Region, Falkevej 1-3, 8600, Silkeborg, Denmark
| | - Petra Dannapfel
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tue Secher Jensen
- Diagnostic Centre - Imaging Section, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Region Denmark, Aarhus, Denmark
| | - Nanna Rolving
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
47
|
Di Donato M, Sheehan LR, Iles R, Gray S, Buchbinder R, Collie A. Patterns of physiotherapy attendance in compensated Australian workers with low back pain: a retrospective cohort study. Pain 2024:00006396-990000000-00562. [PMID: 38563989 DOI: 10.1097/j.pain.0000000000003228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024]
Abstract
ABSTRACT Workers with low back pain (LBP) frequently seek care from physiotherapists. We sought to identify patterns of physiotherapy attendance and factors associated with these patterns in Australian workers with accepted compensation claims for LBP. We included workers with accepted workers' compensation claims for LBP from 4 Australian states between 2011 and 2015. We used trajectory modelling to identify distinct groups of workers based on the number (ie, volume) of monthly physiotherapy attendances over a 2-year period from claim acceptance. Descriptive statistics and logistic regression models were used to compare the characteristics of the groups. A small but significant proportion attend numerous times over a long period. 79.0% of the sample (N = 22,767) attended physiotherapy at least once in the 2 years after claim acceptance. Among these, trajectory modelling identified 4 distinct patterns of attendance. Most (N = 11,808, 51.9%) recorded a short-term low-volume pattern, 26.8% (n = 6089) recorded a short-term high-volume pattern, 14.3% (n = 3255) recorded a long-term low-volume pattern, and 7.1% (n = 1615) recorded a long-term high-volume pattern. Workers from Victoria (OR 0.34, 99% CI 0.31, 0.37), South Australia (OR 0.69, 99% CI 0.60, 0.80), and Western Australia (OR 0.79, 99% CI 0.69, 0.88) were significantly less likely to attend physiotherapy than workers from Queensland. Victorian workers were significantly more likely to be in one of the 2 long-term trajectory groups (OR 8.17, 99% CI 6.86, 9.73; OR 18.68, 99% CI 13.57, 25.70). In conclusion, most compensated Australian workers with LBP attend physiotherapy. Significant interjurisdictional differences between attendance patterns suggests that policy may play an important role in healthcare delivery.
Collapse
Affiliation(s)
- Michael Di Donato
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | | | | |
Collapse
|
48
|
Gushcha AO, Sharif S, Zileli M, Oertel J, Zygourakis CC, Yusupova AR. Acute back pain: Clinical and radiologic diagnosis: WFNS spine committee recommendations. World Neurosurg X 2024; 22:100278. [PMID: 38389960 PMCID: PMC10882106 DOI: 10.1016/j.wnsx.2024.100278] [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: 07/28/2023] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
Objective To formulate the most current, evidence-based recommendations for the clinical and radiologic diagnosis of acute low back pain lasting <4 weeks. Methods A systematic literature search in PubMed and Google Scholar databases was performed from 2012 to 2022 using the search terms "acute back pain AND clinical diagnosis" and "acute back pain AND radiologic diagnosis". Screening criteria resulted in a total of 97 papers analyzed. Using the Delphi method and two rounds of voting, the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated ten final consensus statements. Results Ten final consensus statements address the clinical diagnosis of acute LBP, including which clinical conditions cause acute LBP and how we can distinguish between the different causes of LBP, including discogenic, facet joint, sacroiliac joint, and myofascial pain. The most important step for the radiologic diagnosis of acute LBP is to evaluate the necessity of radiologic investigation, as well as its timing and the most appropriate type of imaging modality. Importantly, imaging should not be a routine diagnostic tool, unless red flag signs are present. In fact, routine imaging for acute LBP can actually have a negative effect as it may reveal incidental radiographic findings that exacerbate patient fear and anxiety. Conclusion Overall, the quality of evidence is not high for most of our consensus statements, and further studies are needed to validate the WFNS Spine Committee recommendations on the clinical and radiographic diagnosis of acute LBP.
Collapse
Affiliation(s)
- Artem O Gushcha
- Department of Neurosurgery, Research Center of Neurology, Moscow, Russia
| | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrberger Str. 90.5, 66421, Homburg, Saar, Germany
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Adilya R Yusupova
- Department of Neurosurgery, Research Center of Neurology, Moscow, Russia
| |
Collapse
|
49
|
Apeldoorn AT, Swart NM, Conijn D, Meerhoff GA, Ostelo RW. Management of low back pain and lumbosacral radicular syndrome: the Guideline of the Royal Dutch Society for Physical Therapy (KNGF). Eur J Phys Rehabil Med 2024; 60:292-318. [PMID: 38407016 PMCID: PMC11112513 DOI: 10.23736/s1973-9087.24.08352-7] [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: 11/26/2023] [Revised: 01/08/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Significant progress and new insights have been gained since the Dutch Physical Therapy guideline on low back pain (LBP) in 2013 and the Cesar en Mensendieck guideline in 2009, necessitating an update of these guidelines. AIM To update and develop an evidence-based guideline for the comprehensive management of LBP and lumbosacral radicular syndrome (LRS) without serious specific conditions (red flags) for Dutch physical therapists and Cesar and Mensendieck Therapists. DESIGN Clinical practice guideline. SETTING Inpatient and outpatient. POPULATION Adults with LBP and/or LRS. METHODS Clinically relevant questions were identified based on perceived barriers in current practice of physical therapy. All clinical questions were answered using published guidelines, systematic reviews, narrative reviews or systematic reviews performed by the project group. Recommendations were formulated based on evidence and additional considerations, as described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework. Patients participated in every phase. RESULTS The guideline describes a comprehensive assessment based on the International Classification of Functioning, Disability and Health (ICF) Core Set for LBP and LRS, including the identification of alarm symptoms and red flags. Patients are assigned to three treatment profiles (low, moderate and high risk of persistent symptoms) based on prognostic factors for persistent LBP. The guideline recommends offering simple and less intensive support to people who are likely to recover quickly (low-risk profile) and more complex and intensive support to people with a moderate or high risk of persistent complaints. Criteria for initiating and discontinuing physical therapy, and referral to a general practitioner are specified. Recommendations are formulated for information and advice, measurement instruments, active and passive interventions and behavior-oriented treatment. CONCLUSIONS An evidence based physical therapy guideline for the management of patients with LBP and LRS without red flags for physical therapists and Cesar and Mensendieck therapists was developed. Cornerstones of physical therapy assessment and treatment are risk stratification, shared decision-making, information and advice, and exercises. CLINICAL REHABILITATION IMPACT This guideline provides guidance for clinicians and patients to optimize treatment outcomes in patients with LBP and LRS and offers transparency for other healthcare providers and stakeholders.
Collapse
Affiliation(s)
- Adri T Apeldoorn
- Department of Rehabilitation, Noordwest Ziekenhuisgroep Alkmaar, Alkmaar, the Netherlands -
| | - Nynke M Swart
- Royal Dutch Society of Physical Therapy, Amersfoort, the Netherlands
| | - Daniëlle Conijn
- Royal Dutch Society of Physical Therapy, Amersfoort, the Netherlands
| | - Guus A Meerhoff
- Royal Dutch Society of Physical Therapy, Amersfoort, the Netherlands
| | - Raymond W Ostelo
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Free University, Amsterdam, the Netherlands
| |
Collapse
|
50
|
Kirsch EP, Yang LZ, Lee HJ, Parente B, Lad SP. Healthcare resource utilization for chronic low back pain among high-utilizers. Spine J 2024; 24:601-616. [PMID: 38081464 DOI: 10.1016/j.spinee.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/26/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Chronic low back pain is a leading cause of morbidity and is among the largest cost drivers for the healthcare system. Research on healthcare resource utilization of patients with low back pain who are not surgical candidates is limited, and few studies follow individuals who generate high healthcare costs over time. PURPOSE This claims study aimed to identify patients with high-impact mechanical, chronic low back pain (CLBP), quantify their low back pain-related health resource utilization, and explore associated patient characteristics. We hypothesize that patients in the top quartile of healthcare resource utilization in the second year after initial diagnosis will continue to generate considerable back pain-related costs in subsequent years. STUDY DESIGN/SETTING IBM MarketScan Research Databases from 2009-2019 were retrospectively analyzed. PATIENT SAMPLE Adults in the United States with an initial diagnosis of low back pain between 2010 and 2014 who did not have cancer, spine surgery, recent pregnancy, or inflammatory spine conditions, were identified using the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes. To ensure patients had chronic low back pain, it was required that individuals had additional claims with a low back pain diagnosis 6 to 12 and 12 to 24 months after initial diagnosis. OUTCOME MEASURES Cost and utilization of inpatient visits, outpatient visits, emergency room visits, pharmacologic and nonpharmacologic treatment options and imaging for chronic low back pain. METHODS Annual back pain-related costs and the use of pharmacologic and nonpharmacologic treatments for 5 years were analyzed. Logistic regression was utilized to identify factors associated with persistent high spending. RESULTS Of 16,917 individuals who met the criteria for chronic low back pain, 4,229 met the criteria for having high healthcare utilization, defined as being in the top quartile of back pain-related costs in the 12 to 24 months after their initial diagnosis. The mean and median back pain-related cost in the first year after an initial diagnosis was $7,112 (SD $9,670) and $4,405 (Q1 $2,147, Q3 $8,461). Mean and median back pain related costs in the second year were $11,989 (SD $20,316) and $5,935 (Q1 $3,892, Q3 $10,678). Costs continued to be incurred in years 3 to 5 at a reduced rate. The cumulative mean cost for back pain over the 5 years following the initial diagnosis was $31,459 (SD $39,545). The majority of costs were from outpatient services. Almost a quarter of the high utilizers remained in the top quartile of back pain-related costs during years 3 to 5 after the initial diagnosis, and another 19% remained in the top quartile for 2 of the 3 subsequent years. For these two groups combined (42%), the 5-year cumulative mean cost for back pain was $43,818 (SD $48,270). Patient characteristics associated with a higher likelihood of remaining as high utilizers were diabetes, having a greater number of outpatient visits and pharmacologic prescriptions, and lower utilization of imaging services. CONCLUSION This is one of the first studies to use an administrative claims database to identify high healthcare resource utilizers among a population of United States individuals with nonsurgical, chronic low back pain and follow their utilization over time. There was a population of individuals who continued to experience high costs 5 years beyond their initial diagnosis, and the majority of individuals continued to seek outpatient services. Further longitudinal claims research that incorporates symptom severity is needed to understand the economic implications of this condition.
Collapse
Affiliation(s)
- Elayna P Kirsch
- Department of Neurosurgery, Duke University Medical Center, 200 Trent Drive, Blue Zone Durham, NC 27710, USA
| | - Lexie Z Yang
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, Durham, NC 27710, USA
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, Durham, NC 27710, USA
| | - Beth Parente
- Department of Neurosurgery, Duke University Medical Center, 200 Trent Drive, Blue Zone Durham, NC 27710, USA
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, 200 Trent Drive, Blue Zone Durham, NC 27710, USA.
| |
Collapse
|