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Skamagki G, Carpenter C, King A, Wåhlin C. How do Employees with Chronic Musculoskeletal Disorders Experience the Management of Their Condition in the Workplace? A Metasynthesis. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:702-712. [PMID: 36849842 PMCID: PMC10684637 DOI: 10.1007/s10926-023-10099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
This metasynthesis contributes to an understanding of the experiences, perceptions, and attitudes of employees on managing chronic musculoskeletal disorders (CMSDs) at work. Many studies in this field are concerned with prevention or return-to-work (RTW) programmes. However, the purpose of this review was to synthesise evidence that only focuses on the employees' management of their CMSDs at work. The SPIDER framework was used to structure the question "How do employees with CMSDs experience the management of their condition in the workplace"? The literature search focused on articles published between 2011 and 2021, and the search was conducted using the following databases: MEDLINE, SCOPUS, CINAHL, AMED, PsycINFO. The review identified nine articles that explored employees' experiences of managing CMSDs at work. Thematic synthesis was used to create analytic themes which provided a more in-depth discussion of these experiences. The identified themes were: 'employees actively seek ways to manage their conditions', 'influence of work environment on employees with CMSDs' and 'optimising the relationship between employees and managers. This metasynthesis suggests that the ability to negotiate workplace support and manage CMSDs at work is influenced by the cultural and social environment of the organisation. Effective communication, care and trust between the employee is needed. The review also illustrated the need for healthcare professionals to provide support to employees at work.
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Affiliation(s)
- Glykeria Skamagki
- Department of Physiotherapy, School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK.
| | - Christine Carpenter
- Department of Physiotherapy, University of British Columbia, Vancouver, Canada
| | - Andrew King
- Department of Physiotherapy, Coventry University, Coventry, UK
| | - Charlotte Wåhlin
- Department of Health, Medicine and Caring Sciences, Occupational and Environmental Medicine Center, Division of Prevention, Rehabilitation and Community Medicine, Unit of Intervention and Implementation Research, Institute for Environmental Medicine, Linköping University, Karolinska Institutet, Stockholm, Sweden
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Skamagki G, Carpenter C, King A, Wåhlin C. Management of Chronic Musculoskeletal Disorders in the Workplace from the Perspective of Older Employees: A Mixed Methods Research Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159348. [PMID: 35954704 PMCID: PMC9367967 DOI: 10.3390/ijerph19159348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: This mixed methods research (MMR) study explored older employees’ experiences of chronic musculoskeletal disorders (CMSDs) in relation to their employment, their perspectives on managing these conditions in the workplace and the strategies used to facilitate and maintain their roles and responsibilities. The services offered to them were also identified. (2) Methods: A mixed methods exploratory sequential design was implemented. In the first qualitative phase, 16 semi-structured interviews gathered in-depth information from older employees. The findings informed the development of an online questionnaire in the survey phase, which was administered to older employees (N = 107). Both sets of findings were then integrated using a narrative joint display. (3) Results: The phenomena of presenteeism and leaveism were important components of employees’ strategies for managing their condition. The integrated findings highlighted the roles of employers, managers and social support in encouraging disclosure and supporting the management of CMSDs. The results also emphasised how self-management and professional health services are crucial for sustaining employability. (4) Conclusions: Current challenges call for employers to identify effective ways to support the ageing workforce and invest in training opportunities for managers and collaborative opportunities with healthcare professionals and other stakeholders. A flexible, empathetic and resourceful work environment is optimal for supporting sustained employability for an ageing workforce.
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Affiliation(s)
- Glykeria Skamagki
- School of Sport, Exercise and Rehabilitation Sciences, Department of Physiotherapy, University of Birmingham, Birmingham B15 2TT, UK
- Correspondence: ; Tel.: +44-(0)-121-678-1000
| | - Christine Carpenter
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Andrew King
- School of Nursing, Midwifery and Health, Department of Physiotherapy, Coventry University, Coventry CV1 5FB, UK;
| | - Charlotte Wåhlin
- Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Division of Prevention, Division of Rehabilitation and Community Medicine, Linköping University, SE-581 83 Linköping, Sweden;
- Unit of Intervention and Implementation Research, Institute for Environmental Medicine, Karolinska Institute, SE-171 77 Stockholm, Sweden
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Costa N, Blyth FM, Amorim AB, Parambath S, Shanmuganathan S, Schneider CH. Implementation initiatives to improve low back pain care in Australia: a scoping review. PAIN MEDICINE 2022; 23:1979-2009. [PMID: 35758625 DOI: 10.1093/pm/pnac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This scoping review aimed to comprehensively review strategies for implementation of low back pain (LBP) guidelines, policies and models of care in the Australian healthcare system. METHODS A literature search was conducted in MEDLINE, EMBASE, CINAHL, Amed and Web of Science to identify studies that aimed to implement or integrate evidence-based interventions/practices to improve LBP care within Australian settings. RESULTS Twenty-five studies met the inclusion criteria. Most studies targeted primary care settings (n = 13). Other settings included tertiary care (n = 4), community (n = 4), pharmacies (n = 3). One study targeted both primary and tertiary care settings (n = 1). Only 40% of the included studies reported an underpinning framework, model or theory. Implementation strategies most frequently used were evaluative and iterative strategies (n = 14, 56%) and train and educate stakeholders (n = 13, 52%), followed by engage consumers (n = 6, 24%), develop stakeholder relationships (n = 4, 16%), change in infrastructure (n = 4, 16%) and support clinicians (n = 3, 12%). The most common implementation outcomes considered were acceptability (n = 11, 44%) and adoption (n = 10, 40%), followed by appropriateness (n = 7, 28%), cost (n = 3, 12%), feasibility (n = 1, 4%) and fidelity (n = 1, 4%). Barriers included time constraints, funding, and teamwork availability. Facilitators included funding and collaboration between stakeholders. CONCLUSIONS Implementation research targeting LBP appears to be a young field, mostly focusing on training and educating stakeholders in primary care. Outcomes on sustainability and penetration of evidence-based interventions are lacking. There is a need for implementation research guided by established frameworks that consider interrelationships between organisational and system contexts beyond the clinician-patient dyad.
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Affiliation(s)
- Nathalia Costa
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia.,The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Fiona M Blyth
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Anita B Amorim
- The University of Sydney, School of Health Sciences, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Sarika Parambath
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Selvanaayagam Shanmuganathan
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Carmen Huckel Schneider
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Bourke MJ, Ferguson D, Cooke M. Patient Experiences of Self-Management for Chronic Low Back Pain: A Qualitative Study. Phys Ther 2022; 102:6556165. [PMID: 35358311 DOI: 10.1093/ptj/pzac030] [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: 03/04/2021] [Revised: 11/08/2021] [Accepted: 02/02/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Chronic low back pain (CLBP) is a lifelong condition causing disability and distress. One aim of treatment is to enhance self-management. To date, self-management interventions have had limited effectiveness. A greater understanding of self-management for CLBP has the potential to improve future interventional trials. The purpose of this study was to identify the experience of CLBP self-management for patients attending outpatient physical therapy and assess how the experience of CLBP self-management changes over time. METHODS This qualitative study used constructivist grounded theory. Patients with CLBP who were attending an outpatient physical therapy department were recruited using convenience sampling. Each participant attended a semistructured interview. These were audio recorded and transcribed verbatim. The data were coded and thematically analyzed by the lead researcher. Recruitment continued until data saturation. Participants reviewed preliminary themes for validation. RESULTS Six subthemes emerged from 9 interviews: (1) self-doubt, (2) coping day to day, (3) independent discovery, (4) developing resilience, (5) health care: opportunity and threat, and (6) living with pain differently. Two themes took on greatest significance. Self-doubt appeared most strongly and was prevalent in all experiences. However, living with pain differently appeared in those who had developed a level of pain acceptance. These themes formed a conceptual model, "Fluctuating Uncertainty." CONCLUSION The experience of CLBP self-management is one of fluctuating self-doubt. Self-doubt is the predominant experience and is characterized by the perception of pain as a threat and low pain self-efficacy. During times of greater clarity, individuals develop strategies that increase pain self-efficacy and reinforce the perception of pain without threat. These are features of learning to live well with pain. IMPACT CLBP is a lifelong condition requiring self-management. The current study characterizes the self-management strategies used by patients attending physical therapy. The fluctuating nature of these strategies is dependent upon perception of pain and pain self-efficacy. LAY SUMMARY People with CLBP who self-manage their pain fluctuate between attempting to control pain and learning to live with pain. People who understand their condition develop wider-ranging self-management strategies.
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Affiliation(s)
- Maurice John Bourke
- Department of Physiotherapy, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Diarmaid Ferguson
- Department of Physiotherapy, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mary Cooke
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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Volinn E, Loeser JD. What are the Origins of Chronic Back Pain of "Obscure Origins"? Turning Toward Family and Workplace Social Contexts. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:153-163. [PMID: 35370485 PMCID: PMC8961709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Chronic back pain (CBP) is a common symptom throughout the world, and those undergoing it often experience a profound degradation of life. Despite extensive research, it remains an elusive symptom. In most cases, CBP is "non-specific," since bio-mechanisms examined in the clinic do not account for it; another way of saying this is that it is "of obscure origins." This paper re-directs attention towards origins that are distal and usually out of sight from the vantage point of the clinic. CBP as considered here is non-specific, persists ≥ 3 months, and, additionally, interferes with activities of daily life, such as family interaction or work. A theory proposed in the paper draws upon Durkheim's Suicide to explain why exposures in the distal social contexts of family and workplace are fundamentally implicated in CBP. The theory is formed out of previously published studies on family and workplace social contexts of CBP and, in effect, provides a theoretical framework with which to review them. After treatment of CBP in the clinic, patients return to family and workplace contexts. Unless exposures in these contexts are addressed, they serve as continually renewing sources of CBP that remain unabated regardless of mechanism-based treatment in the clinic.
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Affiliation(s)
- Ernest Volinn
- Department of Sociology, University of Utah, Salt Lake
City, UT, USA,To whom all correspondence should be addressed:
Ernest Volinn, PhD, Department of Sociology, University of Utah, Salt Lake City,
UT;
| | - John D. Loeser
- Departments of Neurological Surgery and Anesthesia and
Pain Medicine, University of Washington, Seattle, WA, USA
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Title. Pain 2022; 163:1829-1837. [DOI: 10.1097/j.pain.0000000000002585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
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Rufa A, Kolber MJ, Rodeghero J, Cleland J. The impact of physical therapist attitudes and beliefs on the outcomes of patients with low back pain. Musculoskelet Sci Pract 2021; 55:102425. [PMID: 34298493 DOI: 10.1016/j.msksp.2021.102425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Low back pain (LBP) is a common problem that places a major burden on individuals and society. It has been proposed that patients treated by biomedically oriented clinicians will have worse outcomes than those treated by biopsychosocially oriented clinicians. OBJECTIVE To investigate the impact of physical therapist LBP related attitudes and beliefs on the outcomes of patients with LBP. DESIGN Retrospective cohort design. METHOD United States based physical therapists utilizing the Focus on Therapeutic Outcomes, Inc. (FOTO) database were surveyed using the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Outcomes were measured using average Computerized Lumbar Functional Scale change scores (CLFS) and CLFS residual scores. RESULTS Analysis was performed on outcome data from 78 physical therapist and included 2345 patients. HC-PAIRS was a univariate predictor of average CLFS change scores and average CLFS residual scores. PABS-PT Biomedical subscale was a univariate predictor of average CLFS change scores. After adjusting for confounding variables, higher HC-PAIRS scores and PABS-BM scores were associated with a greater change in average CLFS score, and higher PABS-BM scores were associated with higher CLFS residual scores. CONCLUSION Physical therapists who believed in a stronger relationship between pain and disability had improved patient outcomes.
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Affiliation(s)
- Adam Rufa
- SUNY Upstate Medical University, Syracuse, NY, USA; Nova Southeastern University, Fort Lauderdale, FL, USA.
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Low Back Pain Flares: How do They Differ From an Increase in Pain? Clin J Pain 2021; 37:313-320. [PMID: 33830090 DOI: 10.1097/ajp.0000000000000926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The term flare is commonly used to describe low back pain (LBP) fluctuations, but individuals with LBP consider that it does not always correspond to increased pain. This case cross-over study aimed to: (1) determine the extent to which days with a flare identified according to a multidimensional definition (self-reported flare, SRF) corresponded to days with greater than average pain (pain-defined flare, PDF) and (2) to investigate whether physical and psychosocial features differ between PDF and SRF. MATERIALS AND METHODS Individuals with LBP for ≥3 months (N=126) provided data on flares, physical, and psychosocial features daily for 28 days using a smartphone application. RESULTS Most days with SRF (68%) did not have greater than average pain (ie, PDF), but most days with greater than average pain (64%) were reported as an SRF. On days with SRF-only all physical and psychosocial features were worse than nonflare days. SRF+PDF had lower sleep quality and higher pain intensity, fatigue, disability, pain catastrophizing, and fear avoidance than SRF-only. SRF+PDF had higher pain in the afternoon and evening, disability and pain catastrophizing than PDF-only. Self-efficacy at work and during leisure activities was worse on SRF+PDF days than SRF-only and PDF-only days. DISCUSSION These findings highlight that when individuals with LBP consider they have a flare, they do not always have greater than average pain, but have worse psychosocial features. This emphasizes that flare has broader dimensions than pain alone. Consideration of flare according to broad dimensions is important when investigating symptom fluctuations across different LBP trajectories.
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Volinn E, Loeser JD. Upsurges in the joblessness and opioid epidemics in the United States after the COVID-19 epidemic: the plight of the jobless patient in the clinic. Pain 2021; 162:1608-1611. [PMID: 33657577 DOI: 10.1097/j.pain.0000000000002253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Ernest Volinn
- Department of Sociology, University of Utah, Salt Lake City, UT, United States
| | - John D Loeser
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
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Adams G, Salomons TV. Attending work with chronic pain is associated with higher levels of psychosocial stress. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2021; 5:107-116. [PMID: 34189394 PMCID: PMC8210861 DOI: 10.1080/24740527.2021.1889925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Background and Aims: Much is known about the impact of pain in terms of medical costs and missed work. Less is known about its associations when individuals are present for work. This study examines "presenteeism" by analyzing the psychosocial costs of pain in the workplace, using the 2015 European Working Conditions Survey (EWCS). Methods: We conducted cross-sectional analysis of 2384 individuals with chronic pain and 2263 individuals without pain (matched by age and sex) using data from the 2015 EWCS. We compared groups in terms of the following psychosocial factors: supervisor support, job responsibility, team cohesion, discrimination, threats/abuse, job competency, job reward, sexual harassment, stress, and job security. The groups were also compared in terms of days lost due to illness. Results: People with pain were 64% less likely to view their job as rewarding (odds ratio [OR] = 0.61; 95% confidence interval [CI], 0.57-0.65), 47% more likely to be subjected to threats/abuse in the workplace (OR = 0.68; 95% CI, 0.63-0.73), 30% more likely to report poor supervisor support (OR = 0.77; 95% CI, 0.73-0.82), and 28% more likely to perceive discrimination in the workplace (OR = 0.78; 95% CI, 0.71-0.85). People with pain missed approximately nine more days of work per year than respondents without pain. Conclusions: Chronic pain was associated with lower vocational fulfillment and feelings of being ostracized in the workplace. These findings suggest that the presence of pain in the workplace goes well beyond lost productivity due to absenteeism.
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Affiliation(s)
- Greig Adams
- Department of Psychology and Clinical Language Sciences, University of Reading Harry Pitt Building, Reading, UK
| | - Tim V Salomons
- Department of Psychology and Clinical Language Sciences, University of Reading Harry Pitt Building, Reading, UK.,Department of Psychology, Queen's University, Kingston, Ontario, Canada
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Qualitative Evidence from Studies of Interventions Aimed at Return to Work and Staying at Work for Persons with Chronic Musculoskeletal Pain. J Clin Med 2021; 10:jcm10061247. [PMID: 33802906 PMCID: PMC8002835 DOI: 10.3390/jcm10061247] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 12/25/2022] Open
Abstract
Chronic musculoskeletal pain is a significant burden for employees, employers, and society. However, more knowledge is needed about which interventions reduce sick leave. Interventions were defined as the act or an instance of intervening, provided by different stakeholders. This review synthesizes the experiences of patients, employers, and health professionals concerning the interventions that influence returning to work and staying at work for persons with chronic musculoskeletal pain. A literature search was performed using several combinations of key terms. Overall, 18 qualitative studies published between 2002 and 2018 were included. Qualitative analysis assessed how much confidence could be placed in each review finding. Moderate evidence was found for factors improving the return to work process such as collaboration between stakeholders, including the persons with chronic musculoskeletal pain and support from all involved actors in the process. Moderate evidence was found for self-management strategies and workplace adjustments needed to facilitate more persons to returning to work and staying at work despite pain. This review provides stakeholders, employers, and health professionals’ information that could be used to develop and implement interventions to increase the possibilities for persons with chronic musculoskeletal pain returning to work or staying at work.
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Sharma S, Traeger AC, Reed B, Hamilton M, O'Connor DA, Hoffmann TC, Bonner C, Buchbinder R, Maher CG. Clinician and patient beliefs about diagnostic imaging for low back pain: a systematic qualitative evidence synthesis. BMJ Open 2020; 10:e037820. [PMID: 32830105 PMCID: PMC7451538 DOI: 10.1136/bmjopen-2020-037820] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Overuse of diagnostic imaging for patients with low back pain remains common. The underlying beliefs about diagnostic imaging that could drive overuse remain unclear. We synthesised qualitative research that has explored clinician, patient or general public beliefs about diagnostic imaging for low back pain. DESIGN A qualitative evidence synthesis using a thematic analysis. METHODS We searched MEDLINE, EMBASE, CINAHL, AMED and PsycINFO from inception to 17 June 2019. Qualitative studies that interviewed clinicians, patients and/or general public exploring beliefs about diagnostic imaging for low back pain were included. Four review authors independently extracted data and organised these according to themes and subthemes. We used the Critical Appraisal Skills Programme tool to critically appraise included studies. To assess confidence in review findings, we used the GRADE-Confidence in the Evidence from Reviews of Qualitative Research method. RESULTS We included 69 qualitative studies with 1747 participants. Key findings included: Patients and clinicians believe diagnostic imaging is an important test to locate the source of low back pain (33 studies, high confidence); patients with chronic low back pain believe pathological findings on diagnostic imaging provide evidence that pain is real (12 studies, moderate confidence); and clinicians ordered diagnostic imaging to reduce the risk of a missed diagnosis that could lead to litigation, and to manage patients' expectations (12 studies, moderate confidence). CONCLUSION Clinicians and patients can believe that diagnostic imaging is an important tool for locating the source of non-specific low back pain. Patients may underestimate the harms of unnecessary imaging tests. These beliefs could be important targets for intervention. PROSPERO REGISTRATION NUMBER CRD42017076047.
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Affiliation(s)
- Sweekriti Sharma
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben Reed
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melanie Hamilton
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Denise A O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tammy C Hoffmann
- Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Carissa Bonner
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Robart R, Boyle P. Supporting workers with lower back injuries to return to work: a meta-ethnography. Br J Occup Ther 2020. [DOI: 10.1177/0308022620930609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Lower back injuries can prevent people from engaging in the occupation of work, which is considered to be beneficial to physical and mental wellbeing. Return-to-work programmes aim to support people to re-engage with work; however, the success of these can be varied. The aim of this review was to explore what factors facilitated a return to work for those in employment, and what the factors may be in preventing others from making a successful return to work. Method A systematic search of the literature identified 10 qualitative research studies, and a meta-ethnographic approach was then used to critique and synthesise the findings to provide a line of argument. Findings Interrogation of the selected studies brought about three third-order interpretations as follows: enabling injured workers to return to work safely; challenging negative assumptions; overcoming organisational barriers. Conclusion The study supports previous findings that emphasise consideration of wider organisational and psychosocial factors relating to supporting people to return to work, rather than focusing solely on the injured worker. Suggestions are made for the modification of current work practices, the need for a strength-based approach to rehabilitation and for occupational therapists who might work with people living with back pain.
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Affiliation(s)
| | - Paul Boyle
- School of Health Sciences, University of Brighton, UK
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14
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Costa N, Hodges PW, Ferreira ML, Makovey J, Setchell J. What Triggers an LBP Flare? A Content Analysis of Individuals' Perspectives. PAIN MEDICINE 2020; 21:13-20. [PMID: 30889235 DOI: 10.1093/pm/pnz021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE For many, low back pain (LBP) is a lifelong condition with symptoms varying over time. Previous studies have investigated long-term risk factors and triggers for onset of LBP. No study has examined causes for less distinct fluctuations of symptoms, such as "flares," which individuals with LBP identify as a significant and worrisome part of LBP. As little is known about what triggers this type of fluctuation, we aimed to investigate individuals' perspectives on LBP flare triggers. METHODS We conducted an online survey of 130 people with LBP, asking what they think triggers their flares. Data were qualitatively examined using content analysis. RESULTS Most participants identified biomedical (84.8%) triggers, endorsing physical/biological factors to explain the flare occurrence. Themes included active movements (35% of participants), static postures (28.1%), overdoing a task (5.3%), biomechanical dysfunction (4.4%), comorbidities (4%), lack of exercise (3.3%), work (1.8%), and medications (1.5%). Nonbiomedical triggers were reported by 15.2% and included psychosocial and contextual factors, including psychological state (6%), weather (5%), sleep (2%), diet (1.2%), and fatigue (1%). These results indicate that individuals consider biomedical factors to be the main triggers of LBP flares, but some acknowledge nonbiomedical triggers. CONCLUSIONS Study findings contrast with current pain theories, which suggest that there is a need for a reduced emphasis on biomedical causes of LBP pain, especially when persistent. Recognition of patients' views on causes of LBP flares is crucial to better guide clinical practice and inform further research. The validity of triggers identified by LBP patients requires further investigation.
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Affiliation(s)
- Nathalia Costa
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Manuela L Ferreira
- Institute of Bone and Joint Research/The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Joanna Makovey
- Institute of Bone and Joint Research/The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Impact of flare-ups on the lives of individuals with low back pain: A qualitative investigation. Musculoskelet Sci Pract 2019; 43:52-57. [PMID: 31260931 DOI: 10.1016/j.msksp.2019.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/29/2019] [Accepted: 06/24/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Investigating flare-ups has become relevant to understanding and managing low back pain (LBP), particularly because there has been a shift in the conceptualization of LBP from acute or chronic to fluctuating or episodic. Available research mainly consists of quantitative studies, which are unable to fully explore the perspectives of individuals with LBP. This study aimed to address this gap by exploring the changes in individual's lives when they experience LBP flare-up. DESIGN AND PARTICIPANTS A qualitative survey of 130 adult participants with LBP was conducted online, and data analyzed via thematic analysis. RESULTS The themes from the analysis were: 1) sense of disablement, 2) changes in mood, 3) use of coping strategies, and 4) lack of understanding from other people. Participants described LBP flare-ups as having a negative impact on many areas of their lives, with a few even expressing suicidal ideations. CONCLUSIONS Results suggest the importance of considering that LBP flare-ups impact individuals' lives in a complex manner including psychosocial and functional effects. Clinicians should consider this complexity in their interactions with, and management of, patients with LBP flare-ups. Additional education may be required to better equip clinicians for these numerous aspects.
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16
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People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. J Physiother 2019; 65:124-135. [PMID: 31227280 DOI: 10.1016/j.jphys.2019.05.010] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 12/15/2022] Open
Abstract
QUESTION What health information needs are perceived by people with low back pain? DESIGN Systematic review of publications examining perceived health information needs related to low back pain identified through Medline, EMBASE, CINAHL and PsycINFO (1990 to 2018). PARTICIPANTS Adults with low back pain of any duration. DATA EXTRACTION AND ANALYSIS Two reviewers independently extracted descriptive data regarding study design and methodology, and assessed risk of bias. Aggregated findings of the perceived needs of people with low back pain regarding health information were meta-synthesised. RESULTS Forty-one studies (34 qualitative, four quantitative and three mixed-methods) were identified. Two major areas of perceived health information needs for low back pain emerged. The first major area was needs related to information content: general information related to low back pain, its cause and underlying pathology; strong desire for diagnosis and imaging; prognosis, future disability and effect on work capacity; precipitants and management of flares; general management approaches; self-management strategies; prevention; and support services. The second major area of needs related to how the information was delivered. People with low back pain wanted clear, consistent information delivered in suitable tone and understandable language. CONCLUSION Available data suggest that the information needs of people with low back pain are centred around their desire for a diagnosis, potentially contributing to expectations for and overuse of imaging. People with low back pain expressed a strong desire for clear, consistent and personalised information on prognosis, treatment options and self-management strategies, related to healthcare and occupational issues. To correct unhelpful beliefs and optimise delivery of evidence-based therapy, patient and healthcare professional education (potentially by an integrated public health approach) may be warranted.
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Movahed E, Morowatisharifabad MA, Farokhzadian J, Nikooie R, Hosseinzadeh M, Askarishahi M, Bidaki R. Antiretroviral Therapy Adherence Among People Living With HIV: Directed Content Analysis Based on Information-Motivation-Behavioral Skills Model. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 40:47-56. [PMID: 31216259 DOI: 10.1177/0272684x19858029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Antiretroviral therapy (ART) is one of the complexities of treatment and care for people living with HIV (PLHIV). It is essential to understand the challenges of admitting ART in PLHIV based on the Information Motivation Behavioral skills (IMB) model. This study was conducted using qualitative and directed content analysis on 15 participants. The participants included 10 patients and five health-care providers selected from the behavioral diseases counseling center affiliated with a medical university in southeast of Iran using purposive sampling method. Data were collected through semistructured interviews. Data analysis has led to three main categories—information, motivation, and behavioral skills—and eight subcategories. ART adherence in an Iranian context is like an iceberg that the IMB model can deeply identify underwater and unanticipated motivations and factors that lead to nonadherence. Therefore, it can be useful in designing and developing context-based nonadherence to ART interventions.
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Affiliation(s)
- Ehsan Movahed
- 1 Health Education and Health Promotion, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | | | - Rohollah Nikooie
- 4 Department of Exercise Physiology, Faculty of Sports Sciences, Shahid Bahonar University, Kerman, Iran
| | - Mahdieh Hosseinzadeh
- 5 Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohsen Askarishahi
- 6 Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reza Bidaki
- 7 Research Center of Addiction and Behavioral Sciences & Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Improvement in Work Ability, Psychological Distress and Pain Sites in Relation to Low Back Pain Prognosis: A Longitudinal Observational Study in Primary Care. Spine (Phila Pa 1976) 2019; 44:E423-E429. [PMID: 30234815 DOI: 10.1097/brs.0000000000002860] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective observational study pooled from two clinical cohorts. OBJECTIVE To investigate the longitudinal relation between multisite pain, psychological distress, and work ability with disability, pain, and quality of life. SUMMARY OF BACKGROUND DATA Knowledge of prognostic factors is essential for better management of patients with low back pain (LBP). All domains of the biopsychosocial model have shown prognostic value; however, clinical studies rarely incorporate all domains when studying treatment outcome for patients with LBP. METHODS A total of 165 patients with nonspecific LBP seeking primary care physiotherapy were included. Mixed-effects models were used to estimate longitudinal relations between the exposure variables and concurrent measures of outcomes at baseline and 3 months. Logistic regression was used to estimate odds ratios for minimal important difference in outcome. RESULTS Higher work ability was associated with less disability -2.6 (95% confidence interval [CI]: -3.3, -2.0), less pain: -0.4 (95% CI: -0.5, -0.3), and higher quality of life 0.03 (95% CI: 0.02, 0.04). Higher psychological distress and number of pain sites were associated with higher disability: 10.9 (95% CI: 7.7, 14.1) and 2.3 (95% CI: 1.4, 3.2) higher pain: 1.9 (95% CI: 1.3, 2.5) and 0.4 (95% CI: 0.2, 0.5), and lower quality of life: -0.1 (95% CI: -0.2, -0.1) and -0.02 (95% CI: -0.03, -0.01), respectively. Improvement in work ability showed consistent associations with successful outcome for disability (odds ratio [OR]: 4.8, 95% CI: 1.3, 18.1), pain (OR: 3.6, 95% CI: 1.1, 12.1), and quality of life (OR: 4.5, 95% CI: 1.4, 15.1) at 3 months. Reduced psychological distress was associated with improvement in pain only (OR 4.0, 95% CI: 1.3, 12.3). CONCLUSION More pain sites, higher psychological distress, or lower work ability showed higher disability, more pain, and lower quality of life in patients with LBP. Only improvement in work ability was consistently related to successful outcomes. LEVEL OF EVIDENCE 2.
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19
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Costa N, Ferreira ML, Setchell J, Makovey J, Dekroo T, Downie A, Diwan A, Koes B, Natvig B, Vicenzino B, Hunter D, Roseen EJ, Rasmussen-Barr E, Guillemin F, Hartvigsen J, Bennell K, Costa L, Macedo L, Pinheiro M, Underwood M, Van Tulder M, Johansson M, Enthoven P, Kent P, O'Sullivan P, Suri P, Genevay S, Hodges PW. A Definition of "Flare" in Low Back Pain: A Multiphase Process Involving Perspectives of Individuals With Low Back Pain and Expert Consensus. THE JOURNAL OF PAIN 2019; 20:1267-1275. [PMID: 30904517 DOI: 10.1016/j.jpain.2019.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/25/2019] [Accepted: 03/16/2019] [Indexed: 11/19/2022]
Abstract
Low back pain (LBP) varies over time. Consumers, clinicians, and researchers use various terms to describe LBP fluctuations, such as episodes, recurrences and flares. Although "flare" is use commonly, there is no consensus on how it is defined. This study aimed to obtain consensus for a LBP flare definition using a mixed-method approach. Step 1 involved the derivation of a preliminary candidate flare definition based on thematic analysis of views of 130 consumers in consultation with an expert consumer writer. In step 2, a workshop was conducted to incorporate perspectives of 19 LBP experts into the preliminary flare definition, which resulted in 2 alternative LBP flare definitions. Step 3 refined the definition using a 2-round Delphi consensus with 50 experts in musculoskeletal conditions. The definition favored by experts was further tested with 16 individuals with LBP in step 4, using the definition in three scenarios. This multiphase study produced a definition of LBP flare that distinguishes it from other LBP fluctuations, represents consumers' views, involves expert consensus, and is understandable by consumers in clinical and research contexts: "A flare-up is a worsening of your condition that lasts from hours to weeks that is difficult to tolerate and generally impacts your usual activities and/or emotions." Perspective: A multiphase process, incorporating consumers' views and expert consensus, produced a definition of LBP flare that distinguishes it from other LBP fluctuations.
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Affiliation(s)
- Nathalia Costa
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Manuela L Ferreira
- The University of Sydney, Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, Sydney, Australia
| | - Jenny Setchell
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Joanna Makovey
- The University of Sydney, Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, Sydney, Australia
| | - Tanya Dekroo
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Aron Downie
- Musculoskeletal Health Sydney, University of Sydney, Sydney, Australia; Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Ashish Diwan
- Spine Service, Department of Orthopaedic Surgery, St. George & Sutherland Clinical School, University of New South Wales Australia, Kogarah, Sydney, Australia
| | - Bart Koes
- Department of General Practice, Erasmus MC, Rotterdam, the Netherlands; Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Bard Natvig
- Institute for Health and Society, Department of General Practice, University of Oslo, Oslo, Norway
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - David Hunter
- The University of Sydney, Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Eric J Roseen
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Eva Rasmussen-Barr
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden
| | - Francis Guillemin
- Universite de Lorraine, CHRU Nancy, Inserm, CIC1433-Epidemiologie Clinique, Nancy, France
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, The University of Melbourne, Victoria, Australia
| | - Leonardo Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Luciana Macedo
- McMaster University School of Rehabilitation Science Hamilton, Ontario, Canada
| | - Marina Pinheiro
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Martin Underwood
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Mauritus Van Tulder
- Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam Movement Science research institute, Amsterdam, the Netherlands
| | - Melker Johansson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom; Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Paul Enthoven
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Peter Kent
- Department of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Peter O'Sullivan
- Department of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Pradeep Suri
- Seattle Epidemiologic Research and Information Center (ERIC) and Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; New England Baptist Hospital, Boston, Massachusetts; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Stephane Genevay
- Division of Rheumatology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Paul W Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.
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Holland P, Clayton S. Navigating employment retention with a chronic health condition: a meta-ethnography of the employment experiences of people with musculoskeletal disorders in the UK. Disabil Rehabil 2019; 42:1071-1086. [DOI: 10.1080/09638288.2018.1519041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Paula Holland
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
- Arthritis Research UK-MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Stephen Clayton
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
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21
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Chou L, Ranger TA, Peiris W, Cicuttini FM, Urquhart DM, Sullivan K, Seneviwickrama M, Briggs AM, Wluka AE. Patients' perceived needs for medical services for non-specific low back pain: A systematic scoping review. PLoS One 2018; 13:e0204885. [PMID: 30408039 PMCID: PMC6224057 DOI: 10.1371/journal.pone.0204885] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/17/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND An improved understanding of patients' perceived needs for medical services for low back pain (LBP) will enable healthcare providers to better align service provision with patient expectations, thus improving patient and health care system outcomes. Thus, we aimed to identify the existing literature regarding patients' perceived needs for medical services for LBP. METHODS A systematic scoping review was performed of publications identified from MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016). Descriptive data regarding each study, its design and methodology were extracted and risk of bias assessed. Aggregates of patients' perceived needs for medical services for LBP were categorised. RESULTS 50 studies (35 qualitative, 14 quantitative and 1 mixed-methods study) from 1829 were relevant. Four areas of perceived need emerged: (1) Patients with LBP sought healthcare from medical practitioners to obtain a diagnosis, receive management options, sickness certification and legitimation for their LBP. However, there was dissatisfaction with the cursory and superficial approach of care. (2) Patients had concerns about pharmacotherapy, with few studies reporting on patients' preferences for medications. (3) Of the few studies which examined the patients' perceived need of invasive therapies, these found that patients avoided injections and surgeries (4) Patients desired spinal imaging for diagnostic purposes and legitimation of symptoms. CONCLUSIONS Across many different patient populations with data obtained from a variety of study designs, common themes emerged which highlighted areas of patient dissatisfaction with the medical management of LBP, in particular, the superficial approach to care perceived by patients and concerns regarding pharmacotherapy. Patients perceive unmet needs from medical services, including the need to obtain a diagnosis, the desire for pain control and the preference for spinal imaging. These issues need to be considered in developing approaches for the management of LBP in order to improve patient outcomes.
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Affiliation(s)
- Louisa Chou
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tom A. Ranger
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Waruna Peiris
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Flavia M. Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Donna M. Urquhart
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kaye Sullivan
- Monash University Library, Monash University, Melbourne, Victoria, Australia
| | - Maheeka Seneviwickrama
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew M. Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- MOVE: muscle, bone & joint health, Victoria, Australia
| | - Anita E. Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
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22
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Flynn JP, Gascon G, Doyle S, Matson Koffman DM, Saringer C, Grossmeier J, Tivnan V, Terry P. Supporting a Culture of Health in the Workplace: A Review of Evidence-Based Elements. Am J Health Promot 2018; 32:1755-1788. [PMID: 29806469 DOI: 10.1177/0890117118761887] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify and evaluate the evidence base for culture of health elements. DATA SOURCE Multiple databases were systematically searched to identify research studies published between 1990 and 2015 on culture of health elements. STUDY INCLUSION AND EXCLUSION CRITERIA Researchers included studies based on the following criteria: (1) conducted in a worksite setting; (2) applied and evaluated 1 or more culture of health elements; and (3) reported 1 or more health or safety factors. DATA EXTRACTION Eleven researchers screened the identified studies with abstraction conducted by a primary and secondary reviewer. Of the 1023 articles identified, 10 research reviews and 95 standard studies were eligible and abstracted. DATA SYNTHESIS Data synthesis focused on research approach and design as well as culture of health elements evaluated. RESULTS The majority of published studies reviewed were identified as quantitative studies (62), whereas fewer were qualitative (27), research reviews (10), or other study approaches. Three of the most frequently studied culture of health elements were built environment (25), policies and procedures (28), and communications (27). Although all studies included a health or safety factor, not all reported a statistically significant outcome. CONCLUSIONS A considerable number of cross-sectional studies demonstrated significant and salient correlations between culture of health elements and the health and safety of employees, but more research is needed to examine causality.
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Affiliation(s)
| | | | | | | | | | | | | | - Paul Terry
- 6 Health Enhancement Research Organization, Waconia, MN, USA
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23
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Chou L, Cicuttini FM, Urquhart DM, Anthony SN, Sullivan K, Seneviwickrama M, Briggs AM, Wluka AE. People with low back pain perceive needs for non-biomedical services in workplace, financial, social and household domains: a systematic review. J Physiother 2018; 64:74-83. [PMID: 29574167 DOI: 10.1016/j.jphys.2018.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 09/03/2017] [Accepted: 02/14/2018] [Indexed: 11/25/2022] Open
Abstract
QUESTION What needs of non-biomedical services are perceived by people with low back pain? DESIGN Systematic review of qualitative and quantitative studies examining perceived needs of non-biomedical services for low back pain, identified through searching of MEDLINE, EMBASE, CINAHL and PsycINFO (1990 to 2016). PARTICIPANTS Adults with low back pain of any duration. DATA EXTRACTION AND ANALYSIS Descriptive data regarding study design and methodology were extracted. The preferences, expectations and satisfaction with non-biomedical services reported by people with low back pain were identified and categorised within areas of perceived need. RESULTS Twenty studies (19 qualitative and one quantitative) involving 522 unique participants (total pool of 590) were included in this systematic review. Four areas emerged. Workplace: people with low back pain experience pressure to return to work despite difficulties with the demands of their occupation. They want their employers to be informed about low back pain and they desire workplace accommodations. Financial: people with low back pain want financial support, but have concerns about the inefficiencies of compensation systems and the stigma associated with financial remuneration. Social: people with low back pain report feeling disconnected from social networks and want back-specific social support. Household: people with low back pain report difficulties with household duties; however, there are few data regarding their need for auxiliary devices and domestic help. CONCLUSION People with low back pain identified work place, financial and social pressures, and difficulties with household duties as areas of need beyond their healthcare requirements that affect their ability to comply with management of their condition. Consideration of such needs may inform physiotherapists, the wider health system, social networks and the workplace to provide more relevant and effective services. [Chou L, Cicuttini FM, Urquhart DM, Anthony SN, Sullivan K, Seneviwickrama M, Briggs AM, Wluka AE (2018) People with low back pain perceive needs for non-biomedical services in workplace, financial, social and household domains: a systematic review. Journal of Physiotherapy 64: 74-83].
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Affiliation(s)
- Louisa Chou
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne
| | - Donna M Urquhart
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne
| | - Shane N Anthony
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne
| | - Kaye Sullivan
- Monash University Library, Monash University, Melbourne
| | - Maheeka Seneviwickrama
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth; MOVE muscle, bone & joint health, Melbourne, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne
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24
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Do Physical Activities Trigger Flare-ups During an Acute Low Back Pain Episode?: A Longitudinal Case-Crossover Feasibility Study. Spine (Phila Pa 1976) 2018; 43:427-433. [PMID: 28700451 DOI: 10.1097/brs.0000000000002326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, longitudinal case-crossover study. OBJECTIVE The aim of this study was to determine whether physical activities trigger flare-ups of pain during the course of acute low back pain (LBP). SUMMARY OF BACKGROUND DATA .: There exist no evidence-based estimates for the transient risk of pain flare-ups associated with specific physical activities, during acute LBP. METHODS Participants with LBP of duration <3 months completed frequent, Internet-based serial assessments at both 3- and 7-day intervals for 6 weeks. At each assessment, participants reported whether they had engaged in specific physical activity exposures, or experienced stress or depression, during the past 24 hours. Participants also reported whether they were currently experiencing a LBP flare-up, defined as "a period of increased pain lasting at least 2 hours, when your pain intensity is distinctly worse than it has been recently." Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for associations between potential triggers during the past 24 hours, and the risk of LBP flare-ups, using conditional logistic regression. RESULTS Of 48 participants followed longitudinally, 30 participants had both case ("flare") and control periods and contributed data to the case-crossover analysis. There were 81 flare periods and 247 control periods, an average of 11 periods per participant. Prolonged sitting (>6 hours) was the only activity that was significantly associated with flare-ups(OR 4.4, 95% CI 2.0-9.7; P < 0.001). Having either stress or depression was also significantly associated with greater risk of flare-ups (OR 2.5, 95% CI 1.0-6.0; P = 0.04). In multivariable analyses, prolonged sitting (OR 4.2, 95% CI 1.9-9.1; P < 0.001), physical therapy (PT) (OR 0.4, 95% CI 0.1-1.0; P = 0.05), and stress/depression (OR 2.8, 95% CI 1.2-6.7; P = 0.02) were independently and significantly associated with LBP flare-up risk. CONCLUSION Among participants with acute LBP, prolonged sitting (>6 hours) and stress or depression triggered LBP flare-ups. PT was a deterrent of flare-ups. LEVEL OF EVIDENCE 2.
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25
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Ketelaar SM, Schaafsma FG, Geldof MF, Boot CRL, Kraaijeveld RA, Shaw WS, Bültmann U, Twisk J, Anema JR. Employees' Perceptions of Social Norms as a Result of Implementing the Participatory Approach at Supervisor Level: Results of a Randomized Controlled Trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:319-328. [PMID: 27557825 PMCID: PMC5591363 DOI: 10.1007/s10926-016-9659-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Purpose A multifaceted implementation strategy was targeted at supervisors to encourage them to apply a participatory approach (PA) in dealing with employees' work functioning problems due to health concerns. This paper assesses the effect on employees' perceived social norms regarding the use of the PA to deal with work functioning problems. Methods Three organizations participated in a cluster randomized controlled trial, with randomization at the department level. Supervisors in the PA intervention departments received the implementation strategy consisting of a working group meeting, supervisor training, and optional coaching. Supervisors in the control departments received written information about the PA only. In two of the organizations, employees were invited to complete surveys at baseline and at 6-month follow-up. The primary outcome was perceived social norms regarding the use of the PA to deal with work functioning problems. Secondary measures included attitudes and self-efficacy, and intention regarding joint problem solving, and sick leave data. Effects were analyzed using multilevel analyses to account for nesting of cases. Results At baseline, 273 employees participated in the survey, with follow-up analyses of 174 employees. There were no statistically significant group effects on employee outcome measures. The intervention group showed a larger reduction in mean sick days (from 4.6 to 2.4 days) versus the control group (from 3.8 to 3.6 days), but this difference did not reach statistical significance (p > .05). Conclusion The multifaceted strategy to implement the participatory approach for supervisors did not show effects on outcomes at the employee level. To gain significant effects at the employee level, may require that an implementation strategy not only targets management and supervisors, but also employees themselves. TRIAL REGISTRATION NTR3733.
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Affiliation(s)
- S M Ketelaar
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - F G Schaafsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
- Research Center for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VU University Medical Center, Amsterdam, The Netherlands.
| | - M F Geldof
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - C R L Boot
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Institute for Work and Health, Toronto, Canada
| | - R A Kraaijeveld
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - W S Shaw
- Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
| | - U Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Twisk
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - J R Anema
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Research Center for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VU University Medical Center, Amsterdam, The Netherlands
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Setchell J, Costa N, Ferreira M, Makovey J, Nielsen M, Hodges PW. What constitutes back pain flare? A cross sectional survey of individuals with low back pain. Scand J Pain 2017; 17:294-301. [PMID: 28866119 DOI: 10.1016/j.sjpain.2017.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Low back pain (LBP) is a lifelong problem for many. In acute episodes, or as a persistent condition, LBP is fluctuating in nature, with pain and other features of the condition varying in intensity and duration over time. Symptom flares (also known as flare ups) contribute to this variation and can have a great impact on the lives of those who have LBP. An important goal of treatments for, and research on, LBP is arguably to decrease symptom flare in both frequency and severity. However, this goal is problematic with little research, and no consensus, on how to define LBP flare. In particular, patients' understandings of LBP flare have received limited attention in the literature. To appropriately address this issue, we sought to understand how flares are conceptualized by individuals with LBP. METHODS We used an inductive, predominantly qualitative methodology, conducting an online survey with 130 individuals who self-reported experiencing LBP. The survey investigated participants' views on LBP flare including its meaning, features and symptoms, and whether 'flare' and 'pain increase' were synonymous. Qualitative analysis of responses involved thematic and content analysis with descriptive statistics used for the quantitative component. RESULTS Our data analysis found that participants identified many aspects of a flare to be important. Qualitative analyses highlighted a number of themes including that LBP flare was conceptualized as: (1) an increase in pain and other uncomfortable sensations such as paraesthesia or muscle tension, (2) an increase in the area, quality and/or duration of symptoms, (3) a reduction in physical, cognitive and/or social functioning, and (4) negative psychological and/or emotional factors. Flare was also discussed as a change that was difficult to settle. When participants considered whether 'flare' and 'pain increase' were synonymous, responses were evenly divided between 'no' (47%) and 'yes' (46%) with remaining participants 'unsure'. CONCLUSIONS The key finding was that many people with LBP do not consider their condition to be flared simply on the basis of a pain increase. In general, other features were required to also change. Results highlighted that a narrow focus on pain is unlikely to differentiate minor pain events from a flare. These findings are important as they contrast with most commonly used definitions of a flare that focus predominantly on pain increase. IMPLICATIONS Our findings have implications for understanding the trajectory of LBP over time. Understandings derived from perspectives of individuals with LBP highlight that defining flare in LBP is complex. In order to provide person-centred care, individual context and experiences should be taken into account. Therefore, understandings of LBP flare require consideration of factors beyond simply an increase in pain. A comprehensive, person-centred understanding of flare that includes a number of features beyond simply an increase in pain intensity is likely to be useful to better identify flares in research settings, assisting endeavours to understand and reduce LBP. Similarly, in clinical settings a nuanced conceptualisation of flare is likely to help health professionals communicate understandings of flare when working with individuals to manage their LBP.
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Affiliation(s)
- Jenny Setchell
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia.
| | - Nathalia Costa
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Manuela Ferreira
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia; Institute of Bone and Joint Research/The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Joanna Makovey
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia; Institute of Bone and Joint Research/The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Mandy Nielsen
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Paul W Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
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Ketelaar SM, Schaafsma FG, Geldof MF, Kraaijeveld RA, Boot CRL, Shaw WS, Bültmann U, Anema JR. Implementation of the Participatory Approach for Supervisors to Increase Self-Efficacy in Addressing Risk of Sick Leave of Employees: Results of a Cluster-Randomized Controlled Trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:247-257. [PMID: 27402346 PMCID: PMC5405097 DOI: 10.1007/s10926-016-9652-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Purpose To study the effectiveness of a multifaceted strategy to implement the participatory approach (PA) for supervisors to increase their self-efficacy in addressing risk of sick leave of employees. Methods Supervisors from three organizations were invited to participate. Randomization was performed at department level. Supervisors (n = 61) in the intervention departments received the implementation strategy consisting of a working group meeting, supervisor training in PA application, and optional supervisor coaching. Supervisors in the control departments (n = 55) received written information on PA. The primary outcome was supervisors' self-efficacy to apply the PA, measured at baseline and 6 months' follow-up. The number of employees with whom supervisors discussed work functioning problems or (risk of) sick leave was also assessed. Effects were tested using multilevel analyses. Results The strategy did not increase self-efficacy to apply the PA. Subgroup analyses showed that self-efficacy increased for supervisors who at baseline reported to have discussed (risk of) sick leave with less than three employees during the last 6 months (B = 1.42, 95 % CI 0.34-2.50). Furthermore, the implementation strategy increased the number of employees with whom supervisors discussed work functioning problems or risk of sick leave (B = 1.26, 95 % CI 0.04-2.48). Conclusion Although the implementation strategy cannot be recommended for all supervisors, for supervisors who less frequently discuss (risk of) sick leave with employees the implementation strategy might be helpful. Trial registration NTR3733.
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Affiliation(s)
- S M Ketelaar
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - F G Schaafsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
- Research Center for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.
| | - M F Geldof
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - R A Kraaijeveld
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - C R L Boot
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
| | - W S Shaw
- Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
| | - U Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J R Anema
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Research Center for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
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Maakip I, Oakman J, Stuckey R. Gender, Cultural Influences, and Coping with Musculoskeletal Pain at Work: The Experience of Malaysian Female Office Workers. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:228-238. [PMID: 27339144 DOI: 10.1007/s10926-016-9650-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose Workers with musculoskeletal pain (MSP) often continue to work despite their condition. Understanding the factors that enable them to remain at work provides insights into the development of appropriate workplace accommodations. This qualitative study aims to explore the strategies utilised by female Malaysian office workers with MSP to maintain productive employment. Methods A qualitative approach using thematic analysis was used. Individual semi-structured interviews were conducted with 13 female Malaysian office workers with MSP. Initial codes were identified and refined through iterative discussion to further develop the emerging codes and modify the coding framework. A further stage of coding was undertaken to eliminate redundant codes and establish analytic connections between distinct themes. Results Two major themes were identified: managing the demands of work and maintaining employment with persistent musculoskeletal pain. Participants reported developing strategies to assist them to remain at work, but most focused on individually initiated adaptations or peer support, rather than systemic changes to work systems or practices. A combination of the patriarchal and hierarchical cultural occupational context emerged as a critical factor in the finding of individual or peer based adaptations rather than organizational accommodations. Conclusions It is recommended that supervisors be educated in the benefits of maintaining and retaining employees with MSP, and encouraged to challenge cultural norms and develop appropriate flexible workplace accommodations through consultation and negotiation with these workers.
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Affiliation(s)
- Ismail Maakip
- School of Psychology and Public Health, Centre for Ergonomics and Human Factors, La Trobe University, Bundoora, VIC, 3086, Australia.
- Faculty of Psychology and Education, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia.
| | - Jodi Oakman
- School of Psychology and Public Health, Centre for Ergonomics and Human Factors, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Rwth Stuckey
- School of Psychology and Public Health, Centre for Ergonomics and Human Factors, La Trobe University, Bundoora, VIC, 3086, Australia
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Holland P, Collins AM. “Whenever I can I push myself to go to work”: a qualitative study of experiences of sickness presenteeism among workers with rheumatoid arthritis. Disabil Rehabil 2016; 40:404-413. [DOI: 10.1080/09638288.2016.1258436] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Paula Holland
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
- Arthritis Research UK-MRC Centre for Musculoskeletal Health and Work, UK
| | - Alison M. Collins
- Centre for Organizational Health and Wellbeing, Lancaster University, Lancaster, UK
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Barker K. A synthesis of qualitative research exploring the barriers to staying in work with chronic musculoskeletal pain. Disabil Rehabil 2016; 38:566-72. [PMID: 26017361 DOI: 10.3109/09638288.2015.1049377] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Qualitative research can help to advance our understanding, management and prevention of work disability. Our aim was to integrate qualitative research findings in order to increase our understanding of barriers to stay in work with chronic pain. METHODS We searched five electronic bibliographic databases until September 2012, supplemented by citation tracking and hand-searching. We used meta-ethnography to synthesis our findings. Central to meta-ethnography is identifying “concepts” and developing a conceptual model. Concepts were compared and organised into categories. RESULTS The following categories can have an impact on the decision to remain in work: struggling to affirm myself as a good worker; balancing life and work in the face of unpredictable symptoms; my work colleagues don't believe me; the system does not facilitate return to work; the battle for legitimacy. CONCLUSIONS Our innovation is to present an internationally relevant model based on a conceptual synthesis. This model highlights the adversarial work experience of people with chronic. The papers span 15 years of qualitative research. A significant finding is that these themes continue to pervade the current work environment for those in pain, and this has clear implications for education, social care and policy. IMPLICATIONS FOR REHABILITATION People with chronic pain face an adversarial struggle to maintain their credibility at work. Strategies to maintain personal credibility can have an adverse effect on working lives. Changes at a systems level are needed to facilitate continuance and return to work. Cultural changes in the way that we view people with pain would help to keep people in work.
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Smyth W, Lindsay D, Holmes C, Gardner A, Rahman KM. Self-reported long-term conditions of nurses and midwives across a northern Australian health service: A survey. Int J Nurs Stud 2016; 62:22-35. [PMID: 27450663 DOI: 10.1016/j.ijnurstu.2016.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Although nurses generally constitute the largest component of the health workforce there is no systematic collection of data about their health status. Similarly, little is known about how nurses manage any long-term condition they may have, which could contribute to their reducing hours of employment or leaving the workforce completely. Such information will become more important against the backdrop of a global shortage of nurses, and ageing of the nursing population. OBJECTIVES This study aimed to identify the types and impacts of reported long-term conditions, and strategies employed by nurses to manage their conditions. DESIGN A cross-sectional survey design was used. SETTINGS The setting was a large regional health service in North Queensland, Australia, comprising a tertiary referral hospital, two residential aged care facilities and several rural and remote hospitals and community health services. PARTICIPANTS All full-time, part-time and casual nurses and midwives employed within the health service were invited to participate; 665 (30.9%) completed surveys were returned. METHODS A paper-based questionnaire, comprising six sections, was individually addressed to all potential participants, together with reply-paid envelopes for returning completed questionnaires. The anonymous questionnaire took approximately 15 to 25min to complete, less time if the nurse reported no long-term conditions. RESULTS Three-fifths of respondents had at least one long-term condition. Respondents older than 50 years were statistically more likely to report having at least one long-term condition (χ(2)=5.64, p=0.018). Back pain, migraine and asthma were the most frequently reported individual conditions; more than one-quarter of respondents reported a condition relating to mental health and wellbeing. Respondents who reported more than one long-term condition compared to a single long-term condition were statistically more likely to have had more years of nursing experience (t=02.2, p=0.03). Nurses used a combination of varied personal and workplace strategies for many conditions; however personal strategies were most frequently used for all conditions. CONCLUSIONS This survey elicited information about reported long-term conditions, and strategies that nurses used to manage the condition they considered most important to them. We recommend that further investigation into how the full range of workplace strategies could be implemented to assist nurses to manage long-term conditions.
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Affiliation(s)
- Wendy Smyth
- Tropical Health Research Unit for Nursing and Midwifery Practice, Townsville Hospital and Health Service, Australia; Nursing, Midwifery and Nutrition, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - David Lindsay
- Nursing, Midwifery and Nutrition, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Colin Holmes
- Nursing, Midwifery and Nutrition, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Anne Gardner
- Australian Catholic University, Canberra, Australia; Nursing, Midwifery and Nutrition, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Kazi Mizanur Rahman
- Population and Social Health Research Program, Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Gold Coast, Queensland, Australia; Public Health, School of Medicine, Gold Coast Campus, Griffith University, Gold Coast, Queensland, Australia
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Igwesi-Chidobe CN, Kitchen S, Sorinola IO, Godfrey EL. “A life of living death”: the experiences of people living with chronic low back pain in rural Nigeria. Disabil Rehabil 2016; 39:779-790. [DOI: 10.3109/09638288.2016.1161844] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Chinonso N. Igwesi-Chidobe
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria (Enugu Campus), Nsukka, Nigeria
| | - Sheila Kitchen
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
| | - Isaac O. Sorinola
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
| | - Emma L. Godfrey
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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Abedini S, Morowatisharifabad MA, Enjezab B, Barkhordari A, Fallahzadeh H. Risk Perception of Nonspecific Low Back Pain among Nurses: A Qualitative Approach. Health Promot Perspect 2014; 4:221-9. [PMID: 25648952 DOI: 10.5681/hpp.2014.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 11/02/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is a common medical problem among nurses. A better understanding of nurses' experiences about LBP may help to develop preventative approaches. The study aimed to explore risk perceptions of nonspecific LBP among nurses in Bandar Abbas City, southern Iran. METHODS This qualitative study conducted as directed content analysis in 2013. Private semi-structured interviews were conducted with a convenience sample of 30 nurses with minimum of 1-year working experience in hospital. The interview questions were based on perceived severity and vulnerability structures of Protection Motivation Theory. All interviews were transcribed and analyzed using thematic analysis. RESULTS Perceived Severity had the following sub-themes: developing disorders in one's own life and profession, psychical and mental consequences, conflicts and problems in family life, and financial problems. Two sub-themes (problems and limitations in hospital's working system, nature of nursing profession) were identified in relation to perceived vulnerability. CONCLUSION Nurses reflected their concerns about the impact of LBP on their job security and their considerations about how their back pain might be interpreted by their employers and co-workers. Importance of transparent medical diagnostic procedure and clinical evidence to justify degree of LBP and its burden on the nurses' performance was also addressed.
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Affiliation(s)
- Sedigheh Abedini
- Department of Public Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Behnaz Enjezab
- Department of Nursing & Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Abolfazl Barkhordari
- Department of Occupational Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Coole C, Birks E, Watson PJ, Drummond A. Communicating with employers: experiences of occupational therapists treating people with musculoskeletal conditions. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:585-95. [PMID: 24043486 DOI: 10.1007/s10926-013-9476-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE Many employed people with musculoskeletal conditions rely on healthcare practitioners, including occupational therapists, for work-related advice and support. Good communication between healthcare practitioners and employers is considered vital in facilitating work retention and return to work. The purpose of this study was to explore the experiences of occupational therapists in communicating with patients' employers. METHODS Qualitative data were collected from the responses of occupational therapists to ten statements/open questions in a questionnaire survey of UK occupational therapists. Data were copied verbatim into word documents and analysed thematically. RESULTS A total of 649 comments were made by 143 respondents. Five themes were identified that were associated with communicating with employers: patient-dependent; employer-dependent; therapist-dependent; extrinsic factors; methods of communication. CONCLUSION This study has identified that communication between occupational therapists and employers is influenced by a number of factors, including those which are outside the therapists' control. These need to be acknowledged and addressed by therapists, their professional organisation, employers, commissioners, therapy service managers, educators and employees in order to support return-to-work and work retention of people with musculoskeletal conditions.
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Affiliation(s)
- Carol Coole
- Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham, NG7 2UH, UK,
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Mestre TA, Teodoro T, Reginold W, Graf J, Kasten M, Sale J, Zurowski M, Miyasaki J, Ferreira JJ, Marras C. Reluctance to start medication for Parkinson's disease: a mutual misunderstanding by patients and physicians. Parkinsonism Relat Disord 2014; 20:608-12. [PMID: 24661467 DOI: 10.1016/j.parkreldis.2014.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/26/2014] [Accepted: 03/01/2014] [Indexed: 11/29/2022]
Abstract
Reluctance to start medication has never been investigated before in PD. We studied reluctance to start medication for PD motor symptoms, namely its prevalence, underlying reasons, drug-specificity, and associated delay in the start of PD medication. A cross-sectional observational international study was conducted. Patients with a clinical diagnosis of PD advised to start antiparkinsonian medication in the previous 5 years were invited to complete a questionnaire in three centers located in North America and Europe. An electronic online survey was sent to physicians through the mailing list of the Movement Disorder Society. 469 participants (201 PD patients, 268 physicians). 40.2% (n = 82) of the patients reported reluctance to start medication, but 88.6% (n = 234/264) of the physicians estimated that ≤20% of their patients with PD had been reluctant to start medication. The most common reasons reported by patients were the fear of side effects (n = 35, 55.6%), followed by non-acceptance of diagnosis (n = 23, 36.5%); fear of a temporally limited benefit was more commonly selected by physicians (n = 92/267, 34.5%). Patients indicated reluctance to start DAs more frequently compared with L-DOPA (OR: 2.22, 95% CI: 1.30, 9.03; p = 0.013) while physicians perceived L-DOPA to be associated with more reluctance (OR: 4.7, 95% CI: 3.41; 6.59; p < 0.0001). Patients with PD and physicians have a different perspective on the issue of reluctance to start medication. There is a need to bring physicians and patients with PD closer to a shared vision of the problem reluctance to start medication.
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Affiliation(s)
- Tiago A Mestre
- Movement Disorders Centre and The Edmond J. Safra Program in Parkinson's disease, Toronto Western Hospital, University Health Network and Division of Neurology, University of Toronto, 399 Bathurst Street, MC-7 402, Toronto, ON M5T 2S8, Canada.
| | - Tiago Teodoro
- Clinical Pharmacology Unit, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisboa, Portugal
| | - William Reginold
- Movement Disorders Centre and The Edmond J. Safra Program in Parkinson's disease, Toronto Western Hospital, University Health Network and Division of Neurology, University of Toronto, 399 Bathurst Street, MC-7 402, Toronto, ON M5T 2S8, Canada
| | - Julia Graf
- Institute of Neurogenetics, University of Luebeck, Germany
| | - Maike Kasten
- Institute of Neurogenetics, University of Luebeck, Germany; Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
| | - Joanna Sale
- Mobility Program Clinical Research Unit, Toronto, Canada
| | - Mateusz Zurowski
- Movement Disorders Centre and The Edmond J. Safra Program in Parkinson's disease, Toronto Western Hospital, University Health Network and Division of Neurology, University of Toronto, 399 Bathurst Street, MC-7 402, Toronto, ON M5T 2S8, Canada; Department of Psychiatry, Toronto Western Hospital, Toronto, Canada
| | - Janis Miyasaki
- Movement Disorders Centre and The Edmond J. Safra Program in Parkinson's disease, Toronto Western Hospital, University Health Network and Division of Neurology, University of Toronto, 399 Bathurst Street, MC-7 402, Toronto, ON M5T 2S8, Canada
| | - Joaquim J Ferreira
- Clinical Pharmacology Unit, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisboa, Portugal
| | - Connie Marras
- Movement Disorders Centre and The Edmond J. Safra Program in Parkinson's disease, Toronto Western Hospital, University Health Network and Division of Neurology, University of Toronto, 399 Bathurst Street, MC-7 402, Toronto, ON M5T 2S8, Canada
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Majchrzycki M, Kocur P, Kotwicki T. Deep tissue massage and nonsteroidal anti-inflammatory drugs for low back pain: a prospective randomized trial. ScientificWorldJournal 2014; 2014:287597. [PMID: 24707200 PMCID: PMC3953439 DOI: 10.1155/2014/287597] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/26/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate whether chronic low back pain therapy with deep tissue massage (DTM) gives similar results to combined therapy consisting of DTM and non-steroid anti-inflammatory drugs (NSAID). DESIGN Prospective controlled randomized single blinded trial. SETTINGS Ambulatory care of rehabilitation. PARTICIPANTS 59 patients, age 51.8 ± 9.0 years, with chronic low back pain. Interventions. 2 weeks of DTM in the treatment group (TG) versus 2 weeks of DTM combined with NSAID in the control group (CG). MAIN OUTCOME MEASURES Visual analogue scale, Oswestry disability index (ODI), and Roland-Morris questionnaire (RM). RESULTS In both the TG and the CG, a significant pain reduction and function improvement were observed. VAS decreased from 58.3 ± 18.2 to 42.2 ± 21.1 (TG) and from 51.8 ± 18.8 to 30.6 ± 21.9 (CG). RM value decreased from 9.8 ± 5.1 to 6.4 ± 4.4 (TG), and from 9.3 ± 5.5 to 6.1 ± 4.6 (CG). ODI value decreased from 29.2 ± 17.3 to 21.4 ± 15.1 (TG) and from 21.4 ± 9.4 to 16.6 ± 9.4 (CG). All pre-post-treatment differences were significant; however, there was no significant difference between the TG and the CG. CONCLUSION DTM had a positive effect on reducing pain in patients with chronic low back pain. Concurrent use of DTM and NSAID contributed to low back pain reduction in a similar degree that the DTM did.
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Affiliation(s)
- Marian Majchrzycki
- Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, 28 Czerwca 1956 roku 135/147, 61-545 Poznan, Poland
| | - Piotr Kocur
- Department of Kinesiotherapy, University School of Physical Education in Poznan, Królowej Jadwigi 27/39, 61-871 Poznan, Poland
| | - Tomasz Kotwicki
- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, 28 Czerwca 1956 roku 135/147, 61-545 Poznan, Poland
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Froud R, Patterson S, Eldridge S, Seale C, Pincus T, Rajendran D, Fossum C, Underwood M. A systematic review and meta-synthesis of the impact of low back pain on people's lives. BMC Musculoskelet Disord 2014; 15:50. [PMID: 24559519 PMCID: PMC3932512 DOI: 10.1186/1471-2474-15-50] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 01/22/2014] [Indexed: 11/18/2022] Open
Abstract
Background Low back pain (LBP) is a common and costly problem that many interpret within a biopsychosocial model. There is renewed concern that core-sets of outcome measures do not capture what is important. To inform debate about the coverage of back pain outcome measure core-sets, and to suggest areas worthy of exploration within healthcare consultations, we have synthesised the qualitative literature on the impact of low back pain on people’s lives. Methods Two reviewers searched CINAHL, Embase, PsycINFO, PEDro, and Medline, identifying qualitative studies of people’s experiences of non-specific LBP. Abstracted data were thematic coded and synthesised using a meta-ethnographic, and a meta-narrative approach. Results We included 49 papers describing 42 studies. Patients are concerned with engagement in meaningful activities; but they also want to be believed and have their experiences and identity, as someone ‘doing battle’ with pain, validated. Patients seek diagnosis, treatment, and cure, but also reassurance of the absence of pathology. Some struggle to meet social expectations and obligations. When these are achieved, the credibility of their pain/disability claims can be jeopardised. Others withdraw, fearful of disapproval, or unable or unwilling to accommodate social demands. Patients generally seek to regain their pre-pain levels of health, and physical and emotional stability. After time, this can be perceived to become unrealistic and some adjust their expectations accordingly. Conclusions The social component of the biopsychosocial model is not well represented in current core-sets of outcome measures. Clinicians should appreciate that the broader impact of low back pain includes social factors; this may be crucial to improving patients’ experiences of health care. Researchers should consider social factors to help develop a portfolio of more relevant outcome measures.
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Affiliation(s)
- Robert Froud
- Warwick Clinical Trials Unit, Warwick Medical School, Gibbet Hill Road, Coventry CV4 7AL, UK.
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Nastasia I, Coutu MF, Tcaciuc R. Topics and trends in research on non-clinical interventions aimed at preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs): a systematic, comprehensive literature review. Disabil Rehabil 2014; 36:1841-56. [PMID: 24472007 DOI: 10.3109/09638288.2014.882418] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study sought to provide an overview of the main topics and trends in contemporary research on successful non-clinical interventions for preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs). METHODS A systematic electronic search (English and French) was performed in ten scientific databases using keywords and descriptors. After screening the identified titles and abstracts using specific sets of criteria, categorical and thematic analyses were performed on the retained articles. RESULTS Five main topics appear to dominate the research: (1) risk factors and determinants; (2) effectiveness of interventions (programmes, specific components, strategies and policies); (3) viewpoints, experiences and perceptions of specific actors involved in the intervention process; (4) compensation issues; and (5) measurement issues. A currently widespread trend is early screening to identify risks factors for appropriate intervention and multidisciplinary, multimodal approaches. Morover, workplace-related psychosocial and ergonomic factors are considered vital to the success and sustainability of return-to-work (RTW) interventions. Finally, involving workplace actors, and more specifically, affected workers, in the RTW process appears to be a powerful force in improving the chances of moving workers away from disabled status. CONCLUSIONS The findings of this literature review provide with information about the main topics and trends in research on rehabilitation interventions, revealing some successful modalities of intervention aimed at preventing prolonged work disability. IMPLICATIONS FOR REHABILITATION Successful intervention for preventing prolonged work disability in workers compensated for WRMSDs address workplace issues: physical and psychosocial demands at work, ability of the workers to fill these demands, work organization and support of the worker, and worker' beliefs and attitudes related to work. Successful intervention promotes collaboration, coordination between all actors and stakeholders involved in the process of rehabilitation. Strategies able to mobilize the employees, employers, insurers and health care providers are still needed to be implemented.
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Affiliation(s)
- Iuliana Nastasia
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) , Montreal, Quebec , Canada and
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, Barker K. Patients' experiences of chronic non-malignant musculoskeletal pain: a qualitative systematic review. Br J Gen Pract 2013; 63:e829-41. [PMID: 24351499 PMCID: PMC3839392 DOI: 10.3399/bjgp13x675412] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/14/2013] [Accepted: 09/06/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Musculoskeletal (MSK) pain is one of the most predominant types of pain and accounts for a large portion of the primary care workload. AIM To systematically review and integrate the findings of qualitative research to increase understanding of patients' experiences of chronic non-malignant MSK pain. DESIGN AND SETTING Synthesis of qualitative research using meta-ethnography using six electronic databases up until February 2012 (Medline, Embase, Cinahl, Psychinfo, Amed and HMIC). METHOD Databases were searched from their inception until February 2012, supplemented by hand-searching contents lists of specific journals for 2001-2011 and citation tracking. Full published reports of qualitative studies exploring adults' own experience of chronic non-malignant MSK pain were eligible for inclusion. RESULTS Out of 24 992 titles, 676 abstracts, and 321 full texts were screened, 77 papers reporting 60 individual studies were included. A new concept of pain as an adversarial struggle emerged. This adversarial struggle was to: 1) affirm self; 2) reconstruct self in time; 3) construct an explanation for suffering; 4) negotiate the healthcare system; and 5) prove legitimacy. However, despite this struggle there is also a sense for some patients of 6) moving forward alongside pain. CONCLUSIONS This review provides a theoretical underpinning for improving patient experience and facilitating a therapeutic collaborative partnership. A conceptual model is presented, which offers opportunities for improvement by involving patients, showing them their pain is understood, and forming the basis to help patients move forward alongside their pain.
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Affiliation(s)
- Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Coventry, UK
| | - Nick Allcock
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Michelle Briggs
- Institute of Health and Wellbeing, Leeds Metropolitan University, Leeds, UK
| | - Eloise Carr
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - JoyAnn Andrews
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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MacNeela P, Doyle C, O'Gorman D, Ruane N, McGuire BE. Experiences of chronic low back pain: a meta-ethnography of qualitative research. Health Psychol Rev 2013; 9:63-82. [DOI: 10.1080/17437199.2013.840951] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Padraig MacNeela
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Catherine Doyle
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - David O'Gorman
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Department of Anaesthesia, Galway University Hospital, Galway, Ireland
| | - Nancy Ruane
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Department of Anaesthesia, Galway University Hospital, Galway, Ireland
| | - Brian E. McGuire
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Department of Anaesthesia, Galway University Hospital, Galway, Ireland
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, Barker K. A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01120] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe alleviation of pain is a key aim of health care yet pain can often remain a puzzle as it is not always explained by a specific pathology. Musculoskeletal (MSK) pain is one of the most predominant kinds of chronic pain and its prevalence is increasing. One of the aims of qualitative research in health care is to understand the experience of illness, and make sense of the complex processes involved. However, the proliferation of qualitative studies can make it difficult to use this knowledge. There has been no attempt to systematically review and integrate the findings of qualitative research in order to increase our understanding of chronic MSK pain. A synthesis of qualitative research would help us to understand what it is like to have chronic MSK pain. Specifically, it would help us understand peoples' experience of health care with the aim of improving it.AimThe aim of this study was to increase our understanding of patients’ experience of chronic non-malignant MSK pain; utilise existing research knowledge to improve understanding and, thus, best practice in patient care; and contribute to the development of methods for qualitative research synthesis.MethodsWe used the methods of meta-ethnography, which aim to develop concepts that help us to understand a particular experience, by synthesising research findings. We searched six electronic bibliographic databases (including MEDLINE, EMBASE and PsycINFO) and included studies up until the final search in February 2012. We also hand-searched particular journals known to report qualitative studies and searched reference lists of all relevant qualitative studies for further potential studies. We appraised each study to decide whether or not to include it. The full texts of 321 potentially relevant studies were screened, of which 77 qualitative studies that explored adults’ experience of chronic non-malignant MSK pain were included. Twenty-eight of these studies explored the experience of fibromyalgia.ResultsOur findings revealed the new concept of an adversarial struggle that explains the experience of people with chronic MSK pain. This included the struggle to affirm self and construct self over time; find an explanation for pain; negotiate the health-care system while feeling compelled to stay in it; be valued and believed; and find the right balance between sick/well and hiding/showing pain. In spite of this struggle, our model showed that some people were able to move forward alongside their pain by listening to their body rather than fighting it; letting go of the old self and finding a new self; becoming part of a community and not feeling like the only one; telling others about pain and redefining relationships; realising that pain is here to stay rather than focusing on diagnosis and cure; and becoming the expert and making choices. We offer unique methodological innovations for meta-ethnography, which allowed us to develop a conceptual model that is grounded in 77 original studies. In particular, we describe a collaborative approach to interpreting the primary studies.ConclusionOur model helps us to understand the experience of people with chronic MSK pain as a constant adversarial struggle. This may distinguish it from other types of pain. This study opens up possibilities for therapies that aim to help a person to move forward alongside pain. Our findings call on us to challenge some of the cultural notions about illness, in particular the expectation of achieving a diagnosis and cure. Cultural expectations are deep-rooted and can deeply affect the experience of pain. We therefore should incorporate cultural categories into our understanding of pain. Not feeling believed can have an impact on a person’s participation in everyday life. The qualitative studies in this meta-ethnography revealed that people with chronic MSK pain still do not feel believed. This has clear implications for clinical practice. Our model suggests that central to the relationship between patient and practitioner is the recognition of the patient as a person whose life has been deeply changed by pain. Listening to a person’s narratives can help us to understand the impact of pain. Our model suggests that feeling valued is not simply an adjunct to the therapy, but central to it. Further conceptual syntheses would help us make qualitative research accessible to a wider relevant audience. Further primary qualitative research focusing on reconciling acceptance with moving forward with pain might help us to further understand the experience of pain. Our study highlights the need for research to explore educational strategies aimed at improving patients’ and clinicians’ experience of care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- F Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Seers
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Warwick, UK
| | - N Allcock
- Faculty of Medicine and Health Sciences, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham, UK
| | - M Briggs
- Institute of Health and Wellbeing, Leeds Metropolitan University, Leeds, UK
| | - E Carr
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | - J Andrews
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Prevalence and characteristics of flare-ups of chronic nonspecific back pain in primary care: a telephone survey. Clin J Pain 2013; 28:573-80. [PMID: 22699128 DOI: 10.1097/ajp.0b013e31823ae173] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the prevalence and characteristics of flare-ups of chronic nonspecific back pain (CNSBP) among primary care patients, and to examine associations with measures of pain severity and psychosocial factors. METHODS Six hundred thirty-four participants with nonspecific back pain were interviewed by telephone 2 years after an initial primary care visit for back pain. Participants experiencing flare-ups in the last 6 months reported on frequency, duration, and other characteristics of flare-ups. Using bivariate and multivariate analyses, we compared individuals with and without CNSBP flare-ups with respect to demographic characteristics, measures of pain severity, and psychosocial factors. RESULTS Approximately 51% of the participants reported flare-ups. Physical activities, including lifting and bending, were the most common perceived triggers of flare-ups. Participants with flare-ups experienced greater levels of pain intensity, disability, opioid medication use, and psychosocial comorbidities. After adjustment for demographic factors, pain intensity, and pain frequency, participants with flare-ups were more disabled than those without [mean (95% confidence interval) disability score 4.2 (3.9-4.4) vs. 3.3 (2.9-3.6); P<0.0001] and demonstrated higher levels of passive coping [mean passive coping score 4.1(3.8-4.3) vs. 3.4 (3.1-3.7); P=0.0008]. DISCUSSION Flare-ups of CNSBP are common among primary care patients, and are independently associated with higher levels of pain intensity, disability, and passive coping. The presence of flare-ups and the perception of activity as a trigger may predispose patients with flare-ups to experience disability not explained by pain intensity alone. Further longitudinal studies are required to better characterize CNSBP flare-ups and determine their clinical implications.
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Coole C, Drummond A, Watson PJ. Individual work support for employed patients with low back pain: a randomized controlled pilot trial. Clin Rehabil 2012; 27:40-50. [PMID: 22701039 DOI: 10.1177/0269215512446839] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the feasibility and effectiveness of individual work support for employed patients with low back pain. DESIGN Pilot randomized controlled trial of a 16-week vocational intervention with six-month follow-up. SETTING Community/outpatient. PARTICIPANTS Fifty-one employed participants concerned about their ability to work due to low back pain. Outcome data was obtained for 38 participants at six-month follow-up. INTERVENTIONS The intervention group received up to eight individually targeted vocational sessions in conjunction with group rehabilitation for low back pain. The control group received group rehabilitation. OUTCOME MEASURES The feasibility of the intervention was assessed by the recruitment rate, drop-out and loss to follow-up of the participants and the content and delivery of the intervention as recorded by the researcher. The primary outcome measure was perceived work ability. RESULTS Seventy-three participants were referred to the study over six months. Eighty-seven individual work support sessions were delivered. Thirty-one participants (61% of those retained in the study) attended more than half of the group rehabilitation sessions. The intervention was influenced by the uptake of group rehabilitation, the willingness of the participants to involve their workplace and of their workplace to involve the research therapist. The effect of the intervention on work ability was equivocal. CONCLUSIONS Although it was possible to recruit participants and to deliver the intervention, considerable methodological problems were identified. However, even if these were addressed, the impact of such interventions is likely to be limited unless there is an integrated approach between healthcare, employers and employees. Further research is required to evaluate work-focused interventions with this client group.
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Affiliation(s)
- Carol Coole
- Faculty of Medicine and Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
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Lippel K. Preserving workers' dignity in workers' compensation systems: an international perspective. Am J Ind Med 2012; 55:519-36. [PMID: 22354856 DOI: 10.1002/ajim.22022] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Workers' compensation systems are among the most generous disability insurance systems in North America, although they are also known to be potentially adversarial and may have iatrogenic effects on claimants. This article examines issues to be considered to ensure fair compensation provided in a way that respects the dignity of workers. METHODS An overview of the literature on characteristics and effects of workers' compensation systems is followed by an analysis based on classic legal methods, including those of comparative law, complemented with interview data to examine three models of disability compensation. RESULTS The first part of the article identifies cross cutting issues to be considered in the examination of the equity of compensation systems and the protection of the dignity of claimants. These include three underpinnings of workers' compensation: the links between a "no-fault" system and the adversarial process, the appropriate use of medical and scientific evidence in the determination of compensability and the application of appropriate measures for promoting return to work. The second part looks at accident compensation in New Zealand, where compensation is available regardless of the cause of the accident, and disability insurance in the Netherlands, where compensation is available regardless of the cause of the disability. It then describes a composite of characteristics favorable to equity drawn from the thirteen workers' compensation systems in Canada. CONCLUSION Systems that succeed in reducing opportunities for adversarial interactions and that provide substantive protection could better promote the dignity of claimants.
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Affiliation(s)
- Katherine Lippel
- Canada Research Chair in Occupational Health and Safety Law, University of Ottawa, Faculty of Law, Civil Law Section, Ontario, Canada.
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Shaw WS, Findley PA, Feuerstein M. Twenty years of multidisciplinary research and practice: the Journal of Occupational Rehabilitation then and now. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:449-54. [PMID: 22065200 DOI: 10.1007/s10926-011-9339-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Early research of work disability in the 1980s showed a complexity of factors influencing pain and health-related functional limitation at work; hence, multidisciplinary perspectives were necessary to understand the complex interplay between biomechanical, organizational, social, and psychological factors impacting work disability. To address this need, the Journal of Occupational Rehabilitation was founded in 1991 with the goal of providing a scientific, yet practical forum for presenting multidisciplinary research and practice in work disability. Now, the 20-year collection of articles in the Journal reflects important trends and directions in the field of occupational rehabilitation. METHODS We conducted a retrospective summary of the past 20 years of the Journal of Occupational Rehabilitation, including its inaugural goals and intent, rates of submission and acceptance, trends in the types of articles published, study topics, global distribution of authors, and future directions. RESULTS The original goal of providing a multidisciplinary scientific and practical forum has been met, but current trends reflect a maturing scientific evidence base, with less representation of employer-based case studies and practical innovations. There has been a dramatic increase in the international representation of studies, authors, and peer reviewers outside of the US. Also, published studies now address work disability for a larger number of health concerns. CONCLUSIONS Contributions to the Journal continue to reflect a multidisciplinary perspective, but the Journal has seen significant changes with respect to international representation, the expanding study of non-musculoskeletal sources of work disability, and the maturing scientific evidence base in the field of occupational rehabilitation. Future volumes of the Journal will likely reflect continuing changes in the global economy, workforce fitness, and job demands.
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Affiliation(s)
- William S Shaw
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA.
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Coole C, Watson PJ, Drummond A. Low back pain patients' experiences of work modifications; a qualitative study. BMC Musculoskelet Disord 2010; 11:277. [PMID: 21134248 PMCID: PMC3016306 DOI: 10.1186/1471-2474-11-277] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 12/06/2010] [Indexed: 11/27/2022] Open
Abstract
Background Research indicates that work modifications can reduce sickness absence and work disability due to low back pain. However, there are few studies that have described modified work from the perspective of patients. A greater understanding of their experiences may inform future workplace management of employees with this condition. Methods Individual semi-structured interviews were conducted with twenty-five employed patients who had been referred for back pain rehabilitation. All had expressed concern about their ability to work due to low back pain. Data was analysed thematically. Results Many participants had made their own work modifications, which were guided by the extent of control they had over their hours and duties, colleague support, and their own beliefs and attitudes about working with back pain. A minority of the participants had received advice or support with work modifications through occupational health. Access to these services was limited and usually followed lengthy sickness absence. Implementation largely rested with the manager and over-cautious approaches were common. Conclusions There was little evidence of compliance with occupational health guidance on modified work. There appears to be insufficient expertise among managers and occupational health in modifying work for employees with low back pain and little indication of joint planning. On the whole, workers make their own modifications, or arrange them informally with their manager and colleagues, but remain concerned about working with back pain. More effective and appropriate application of modifications may increase employees' confidence in their ability to work.
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Affiliation(s)
- Carol Coole
- Division of Rehabilitation and Ageing, School of Community Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
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Coole C, Watson PJ, Drummond A. Staying at work with back pain: patients' experiences of work-related help received from GPs and other clinicians. A qualitative study. BMC Musculoskelet Disord 2010; 11:190. [PMID: 20799938 PMCID: PMC2936348 DOI: 10.1186/1471-2474-11-190] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 08/27/2010] [Indexed: 12/02/2022] Open
Abstract
Background Low back pain commonly affects work ability, but little is known about the work-related help and advice that patients receive from GPs and other clinicians. The purpose of this study was to explore the experiences of employed people with back pain and their perceptions of how GPs and other clinicians have addressed their work difficulties. Methods A qualitative approach with thematic analysis was used. Individual interviews were carried out with twenty-five employed patients who had been referred for back pain rehabilitation. All had expressed concern about their ability to work due to low back pain. Results The perception of the participants was that GPs and other clinicians had provided little or no work-focused guidance and support and rarely communicated with employers. Sickness certification was the main method that GPs used to manage participants' work problems. Few had received assistance with temporary modifications and many participants had remained in work despite the advice they had received. There was little expectation of what GPs and other clinicians could offer to address work issues. Conclusions These findings question the ability of GPs and other clinicians to provide work-focused support and advice to patients with low back pain. Future research is recommended to explore how the workplace problems of patients can be best addressed by health professionals.
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Affiliation(s)
- Carol Coole
- Division of Rehabilitation and Ageing, School of Community Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
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