1
|
Bell EC, Heng H, Alousis N, King MG, Hahne A, Collins T, See K, Webster T, O'Dowd E, Jackson P, Semciw AI. Patient and Staff Insights on Digital Care Pathways for Patients With Low Back Pain in the Emergency Department: A Qualitative Study. Health Expect 2024; 27:e14182. [PMID: 39152538 PMCID: PMC11329376 DOI: 10.1111/hex.14182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/17/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Back pain is a huge global problem. For some people, the pain is so severe that they feel the need to present to an emergency department (ED). Our aim was to explore patient and staff perspectives for the development of a digital care pathway (DCP) for people with back pain who have presented to ED, including acceptability, barriers and facilitators. METHODS We used a descriptive phenomenology approach using semi-structured interviews with patient and staff participants at a tertiary hospital. Interviews were transcribed and data codes were developed using inductive thematic analysis. Themes were discussed between researchers until consensus was achieved. RESULTS A total of 16 interviews were carried out, half of which involved patient participants. We identified three major themes: (i) expectations and experiences of staff and patients with low back pain in ED; (ii) a digital care pathway can empower patients and support clinicians in providing care; and (iii) acceptability, barriers, facilitators and recommendations of engaging with a DCP to track the trajectory of back pain. Each theme was further categorised into subthemes. CONCLUSION Introducing a DCP was perceived as acceptable and beneficial by patients and staff. Both groups were aware of the potential participant burden if surveys were too long. Introducing a DCP could be a valuable adjunct to current management care models, providing a standardised source of education with the potential for individualised tracking and monitoring. The design and development of a DCP will need to consider reported facilitators and address perceived barriers for engagement. PATIENT OR PUBLIC CONTRIBUTION This project sought insights from patients and staff about a digital care pathway. This forms the first step of patient and consumer consultation before implementing a digital care pathway. All consumers were offered the opportunity to review their responses and our interpretation.
Collapse
Affiliation(s)
- Emily C. Bell
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Hazel Heng
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Nicole Alousis
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Matthew G. King
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
| | - Andrew Hahne
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
| | - Thomas Collins
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Katharine See
- Digital Health Division, Clinical Leadership, Effectiveness & OutcomesNorthern HealthEppingAustralia
| | - Tracey Webster
- Digital Health Division, Clinical Leadership, Effectiveness & OutcomesNorthern HealthEppingAustralia
| | - Elisha O'Dowd
- Digital Health Division, Clinical Leadership, Effectiveness & OutcomesNorthern HealthEppingAustralia
| | - Paul Jackson
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Adam I. Semciw
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
- Department of Allied HealthNorthern HealthEppingAustralia
| |
Collapse
|
2
|
Alves SM, Puentedura EJ, Silva AG. Pain neuroscience education and graded exposure versus Pilates and postural education: A pilot study in an occupational context. Physiother Theory Pract 2024; 40:456-467. [PMID: 36111620 DOI: 10.1080/09593985.2022.2122914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Pain neuroscience education (PNE) and graded exposure have not been explored in occupational settings for low back pain (LBP). AIM To pilot feasibility and assess preliminary effectiveness of PNE and graded exposure for LBP. METHODS A pilot study where workers were randomized to either PNE and graded exposure or Pilates and postural education. Both interventions consisted of weekly individual face-to-face sessions for 8 weeks (a total of 8 sessions). The primary outcome was pain intensity. Secondary outcomes were disability, catastrophizing, fear-avoidance, sleep, endurance of back extensor muscles, and patient's perceived impression of change. RESULTS Seventeen participants entered the PNE and graded exposure group and 20 the Pilates and postural education group. PNE and graded exposure were feasible to implement. Between-group comparisons suggest higher improvements in the PNE group for extensor muscle endurance (p < .001, η2p = .29), pain catastrophizing (p < .001; η2p = .56) and fear-avoidance related to physical activity (p < .001; η2p = .48) and work (p < .001; η2p = .47). In the PNE group, at least 13 (76.5%) participants reported being at least "moderately better" against 6 (30%) participants in the Pilates group. CONCLUSION PNE and graded exposure can be successfully implemented in an occupational context and is potentially more beneficial than Pilates and postural education for extensor muscle endurance, catastrophizing, and fear avoidance and similarly as beneficial for pain intensity and disability. Further studies are needed to confirm these results.
Collapse
Affiliation(s)
- Sara M Alves
- Department of Physical Medicine and Rehabilitation, Hospital Center of Vila Nova de Gaia - Espinho, R. Dr. Francisco Sá Carneiro 4400-129, 4430-999, Vila Nova de Gaia, Portugal
| | - Emilio J Puentedura
- Department of Physical Therapy, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Anabela G Silva
- School of Health Sciences and CINTESIS.UA@RISE, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
| |
Collapse
|
3
|
Smalley H, Edwards K. Chronic back pain prevalence at small area level in England - the design and validation of a 2-stage static spatial microsimulation model. Spat Spatiotemporal Epidemiol 2024; 48:100633. [PMID: 38355256 DOI: 10.1016/j.sste.2023.100633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 02/16/2024]
Abstract
Spatially disaggregated estimates provide valuable insights into the nature of a disease. They highlight inequalities, aid public health planning and identify avenues for further research. Spatial microsimulation is advantageous in that it can be used to create large microdata sets with intact microlevel relationships between variables, which allows analysis of relationships between variables locally. This methodological paper outlines the design and validation of a 2-stage static spatial microsimulation model for chronic back pain prevalence across England, suitable for policy modelling. Data used was obtained from the Health Survey for England and the 2011 Census. Microsimulation was performed using SimObesity, a previously validated static deterministic program, and the synthetic chronic back pain microdataset was internally validated. The paper also highlights modelling considerations for researchers embarking on similar work, as well as future directions for research in this area of microsimulation.
Collapse
Affiliation(s)
- Harrison Smalley
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom.
| | - Kimberley Edwards
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
4
|
Fauser D, Zimmer JM, Banaschak H, Golla A, Sternberg A, Mau W, Bethge M. Use of a job exposure matrix to predict the risk of work disability in individuals with back pain: An inception cohort study. Work 2024; 78:829-839. [PMID: 38306084 DOI: 10.3233/wor-230410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Low back pain has a high economic burden in Germany due to back pain-related sick leave, disability pensions, and health care utilization. Work-related factors can predict disabling back pain. Job exposure matrices can be used to consider job demands and occupational characteristics in routine data analysis. OBJECTIVE This longitudinal analysis tested whether rehabilitation utilization due to musculoskeletal disorders is associated with occupation-linked job exposures in employees with back pain. METHODS Data from a German cohort study were used, including employees aged 45 to 59 years with self-reported back pain in the last three months. Individuals' job titles were assessed in the baseline survey in 2017 and matched with parameters of aggregated job exposure indices. Administrative data from the German Pension Insurance were used to extract information on rehabilitation utilization. Proportional hazard models tested the associations. RESULTS We considered data of 6,569 participants (mean age: 52.3 years; 57.7% women). During follow-up, with a maximum of 21 months, 296 individuals (4.5%) utilized medical rehabilitation due to musculoskeletal disorders. Adjusted analyses showed that high physical (HR = 2.87; 95% CI 1.74; 4.75) and overall (HR = 2.34; 95% CI 1.44; 3.80) job exposures were associated with a higher risk of rehabilitation utilization. CONCLUSION Individuals with back pain working in occupations with high physical job exposures have a higher risk for rehabilitation utilization. To prevent work disability in individuals with back pain, occupational groups with high physical job exposures should be actively informed about tailored intervention options.
Collapse
Affiliation(s)
- David Fauser
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Julia-Marie Zimmer
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Hannes Banaschak
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - André Golla
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Annika Sternberg
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Wilfried Mau
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Bethge
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| |
Collapse
|
5
|
Baker TA, Morales KH, Brooks AK, Clark J, Wakita A, Whitt-Glover MC, Yu YZ, Murray M, Hooker SP. A biopsychosocial approach assessing pain indicators among Black men. FRONTIERS IN PAIN RESEARCH 2023; 4:1060960. [PMID: 36860329 PMCID: PMC9968840 DOI: 10.3389/fpain.2023.1060960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/11/2023] [Indexed: 02/15/2023] Open
Abstract
Introduction The lack of empirical evidence documenting the pain experience of Black men may be the result of social messaging that men are to project strength and avoid any expression of emotion or vulnerability. This avoidant behavior however, often comes too late when illnesses/symptoms are more aggressive and/or diagnosed at a later stage. This highlights two key issues - the willingness to acknowledge pain and wanting to seek medical attention when experiencing pain. Methods To better understand the pain experience in diverse raced and gendered groups, this secondary data analysis aimed to determine the influence identified physical, psychosocial, and behavioral health indicators have in reporting pain among Black men. Data were taken from a baseline sample of 321 Black men, >40 years old, who participated in the randomized, controlled Active & Healthy Brotherhood (AHB) project. Statistical models were calculated to determine which indicators (somatization, depression, anxiety, demographics, medical illnesses) were associated with pain reports. Results Results showed that 22% of the men reported pain for more than 30 days, with more than half of the sample being married (54%), employed (53%), and earning an income above the federal poverty level (76%). Multivariate analyses showed that those reporting pain were more likely to be unemployed, earn less income, and reported more medical conditions and somatization tendencies (OR=3.28, 95% CI (1.33, 8.06) compared to those who did not report pain. Discussion Findings from this study indicate that efforts are needed to identify the unique pain experiences of Black men, while recognizing its impact on their identities as a man, a person of color, and someone living with pain. This allows for more comprehensive assessments, treatment plans, and prevention approaches that may have beneficial impacts throughout the life course.
Collapse
Affiliation(s)
- Tamara A. Baker
- Department of Psychiatry, University of North Carolina, School of Medicine, Chapel Hill, NC, United States,Correspondence: Tamara A. Baker
| | - Knashawn H. Morales
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - Amber K. Brooks
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston salem, NC, United States
| | | | - Anna Wakita
- University of North Carolina, Gillings School of Global Public Health Chapel Hill, Chapel Hill, NC, United States
| | | | - Yelia Z. Yu
- Department of Psychiatry, University of North Carolina, School of Medicine, Chapel Hill, NC, United States
| | | | - Steven P. Hooker
- College of Health and Human Services, San Diego State University, San diego, CA, United States
| |
Collapse
|
6
|
Kausto J, Rosenström TH, Ervasti J, Pietiläinen O, Kaila-Kangas L, Rahkonen O, Harkko J, Väänänen A, Kouvonen A, Lallukka T. Intervention targeted at physicians' treatment of musculoskeletal disorders and sickness certification: an interrupted time series analysis. BMJ Open 2021; 11:e047018. [PMID: 34862275 PMCID: PMC8647396 DOI: 10.1136/bmjopen-2020-047018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE An intervention was carried out at the occupational healthcare services (OHS) of the City of Helsinki beginning in 2016. We investigated the association between the intervention and employee sick leaves using interrupted time series analysis. DESIGN Register-based cohort study with a quasi-experimental study design. SETTING Employees of the City of Helsinki. PARTICIPANTS We analysed individual-level register-based data on all employees who were employed by the city for any length of time between 2013 and 2018 (a total 86 970 employees and 3 014 075 sick leave days). Sick leave days and periods that were OHS-based constituted the intervention time series and the rest of the sick leave days and periods contributed to the comparison time series. INTERVENTION Recommendations provided to physicians on managing pain and prescribing sick leave for low back, shoulder and elbow pain. OUTCOME MEASURES Number of sick leave days per month and sick leave periods per year. RESULTS For all sick leave days prescribed at OHS, there was no immediate change in sick leave days, whereas a gradual change showing decreasing number of OHS-based sick leave days was detected. On average, the intervention was estimated to have saved 2.5 sick leave days per year per employee. For other sick leave days, there was an immediate increase in the level of sick leave days after the intervention and a subsequent gradual trend showing decreasing number of sick leave days. CONCLUSIONS The intervention may have reduced employee sick leaves and therefore it is possible that it had led to direct cost savings. However, further evidence for causal inferences is needed.
Collapse
Affiliation(s)
- Johanna Kausto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tom Henrik Rosenström
- Department of Psychology and Logopedics, University of Helsinki Faculty of Medicine, Helsinki, Finland
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Administrative Data Research Centre, Queen's University Belfast, Belfast, UK
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| |
Collapse
|
7
|
Liew BXW, Ford JJ, Scutari M, Hahne AJ. How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data. PLoS One 2021; 16:e0258515. [PMID: 34634071 PMCID: PMC8504753 DOI: 10.1371/journal.pone.0258515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/12/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Individualised physiotherapy is an effective treatment for low back pain. We sought to determine how this treatment works by using randomised controlled trial data to develop a Bayesian Network model. METHODS 300 randomised controlled trial participants (153 male, 147 female, mean age 44.1) with low back pain (of duration 6-26 weeks) received either individualised physiotherapy or advice. Variables with potential to explain how individualised physiotherapy works were included in a multivariate Bayesian Network model. Modelling incorporated the intervention period (0-10 weeks after study commencement-"early" changes) and the follow-up period (10-52 weeks after study commencement-"late" changes). Sequences of variables in the Bayesian Network showed the most common direct and indirect recovery pathways followed by participants with low back pain receiving individualised physiotherapy versus advice. RESULTS Individualised physiotherapy directly reduced early disability in people with low back pain. Individualised physiotherapy exerted indirect effects on pain intensity, recovery expectations, sleep, fear, anxiety, and depression via its ability to facilitate early improvement in disability. Early improvement in disability, led to an early reduction in depression both directly and via more complex pathways involving fear, recovery expectations, anxiety, and pain intensity. Individualised physiotherapy had its greatest influence on early change variables (during the intervention period). CONCLUSION Individualised physiotherapy for low back pain appears to work predominately by facilitating an early reduction in disability, which in turn leads to improvements in other biopsychosocial outcomes. The current study cannot rule out that unmeasured mechanisms (such as tissue healing or reduced inflammation) may mediate the relationship between individualised physiotherapy treatment and improvement in disability. Further data-driven analyses involving a broad range of plausible biopsychosocial variables are recommended to fully understand how treatments work for people with low back pain. TRIALS REGISTRATION ACTRN12609000834257.
Collapse
Affiliation(s)
- Bernard X. W. Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - Jon J. Ford
- Discipline of Physiotherapy, School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Australia
| | - Marco Scutari
- Istituto Dalle Molle di Studi sull’Intelligenza Artificiale (IDSIA), Lugano, Switzerland
| | - Andrew J. Hahne
- Discipline of Physiotherapy, School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Australia
| |
Collapse
|
8
|
Ogbeivor C, Elsabbagh L. Management approach combining prognostic screening and targeted treatment for patients with low back pain compared with standard physiotherapy: A systematic review & meta-analysis. Musculoskeletal Care 2021; 19:436-456. [PMID: 33715261 DOI: 10.1002/msc.1541] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Research evidence suggests that a stratified care management approach is better at improving clinical and economic outcomes for low back pain (LBP) patients compared with usual care in the short-term. However, it is uncertain if these health and economic benefits are sustainable in the longer term. OBJECTIVE To determine the effectiveness of stratified care compared with standard physiotherapy for LBP treatment. METHODS A comprehensive search was undertaken of seven electronic databases (CINAHL, MEDLINE, Pedro, EMBASE, PsycINFO, Cochrane Register for Controlled Trials and Web of Science with full text. No time limits were applied, but studies were limited to English language publications and those involving human participants. Two independent reviewers undertook study selection, data extraction and appraisal of study RESULTS: In total, 6,842 patients (18 years and above) were included in the 8 trials reviewed - 4 were randomised controlled trials (RCTs) and the other 4 were non-RCTs. The pooled analysis of 3 studies (n = 2,460) demonstrated a strong evidence in favour of stratified care over standard care at improving overall pain (WMD [random] 0.46 [95% CI 0.21, 0.71]; P < 0.0003), with overall effect (Z = 3.6) and (RMDQ) scores (WMD [random] 0.71 [95% CI 0.05, 1.37]; P < 0.03), with overall effect (Z = 2.11) at 3, 4- and 6-months follow-up periods. CONCLUSION This current review demonstrated that a stratified care approach provides substantial clinical, economic and health related cost benefits in the medium and high-risk subgroups compared with usual care. Further research is needed for longer-term benefits.
Collapse
Affiliation(s)
- Collins Ogbeivor
- Rehabilitation Department, John Hopkins Aramco Healthcare, Dhahran, Kingdom of Saudi Arabia
| | - Lina Elsabbagh
- Rehabilitation Department, John Hopkins Aramco Healthcare, Dhahran, Kingdom of Saudi Arabia
| |
Collapse
|
9
|
Purushotham S, Stephenson RS, Sanderson A, Falla D. Microscopic changes in the spinal extensor musculature in patients experiencing chronic spinal pain: protocol for a systematic review. BMJ Open 2021; 11:e042729. [PMID: 33619189 PMCID: PMC7903124 DOI: 10.1136/bmjopen-2020-042729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Chronic spinal pain (CSP) is the most common musculoskeletal disorder and is a leading cause of disability as per the Global Burden of Diseases. Previous reviews of microscopic changes in the spinal extensor muscles of people with CSP have focused on the lumbar region only and the results have been inconclusive. Therefore, in this protocol, we aim to assess microscopic changes in the extensor muscles of all spinal regions, investigating regionally specific changes in muscle fibre types of the spinal extensor muscles in patients with non-specific CSP. METHODS/ANALYSIS This protocol was designed using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Searches will use the following databases: MEDLINE, Embase, PubMed, CINAHL Plus and Web of Science along with relevant grey literature searches. Two reviewers will conduct the searches, perform data extraction, apply inclusion criteria and conduct risk of bias assessment using Newcastle-Ottawa Scale. Data will be synthesised and analysed independently. If there is sufficient homogeneity, then meta-analysis will be conducted by the reviewers jointly. If not, meta-synthesis or narrative reporting will be performed. The quality of the evidence will be assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. ETHICS AND DISSEMINATION The results of this study will be submitted for publication to a peer-reviewed journal and will be presented at conferences. Ethical approval for this systematic review was not required due to no patient data being collated. PROSPERO REGISTRATION NUMBER CRD42020198087.
Collapse
Affiliation(s)
- Shilpa Purushotham
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Anatomy Department, Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Robert Stanley Stephenson
- Anatomy Department, Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Andy Sanderson
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
10
|
Development of Prediction Model for the Prognosis of Sick Leave Due to Low Back Pain. J Occup Environ Med 2020; 61:1065-1071. [PMID: 31651601 DOI: 10.1097/jom.0000000000001749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to develop a prediction model for the prognosis of sick leave due to low back pain (LBP). METHODS This is a cohort study with 103 employees sick-listed due to non-specific LBP and spinal disc herniation. A prediction model was developed based on questionnaire data and registered sick leave data with follow up of 180 days. RESULTS At follow up 31 (30.1%) employees were still sick-listed due to LBP. Forward selection procedure resulted in a model with: catastrophizing, musculoskeletal work load, and disability. The explained variance was 27.3%, calibration was adequate and discrimination was fair with area under the ROC-curve (AUC) = 0.761 (interquartile range [IQR]: 0.755-0.770). CONCLUSION The prediction model of this study can adequately predict LBP sick leave after 180 days and could be used for employees sick listed due LBP.
Collapse
|
11
|
Longtin C, Tousignant-Laflamme Y, Coutu MF. A logic model for a self-management program designed to help workers with persistent and disabling low back pain stay at work. Work 2020; 67:395-406. [PMID: 33044220 DOI: 10.3233/wor-203289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Workers with persistent disabling low back pain (LBP) often encounter difficulty staying at work. Self-management (SM) programs can offer interesting avenues to help workers stay at work. OBJECTIVE To establish the plausibility of a logic model operationalizing a SM program designed to help workers with persistent disabling LBP stay at work. METHODS We used a qualitative design. A preliminary version of the logic model was developed based on the literature and McLaughlin et al.'s framework for logic models. Clinicians in work rehabilitation completed an online survey on the plausibility of the logic model and proposed modifications, which were discussed in a focus group. Thematic analyses were performed. RESULTS Participants (n = 11) found the model plausible, contingent upon a few modifications. They raised the importance of making more explicit the margin of maneuver or "job leeway" for a worker who is trying to stay at work and suggested emphasizing a capability approach. Enhancing the workers' perceived self-efficacy and communication skills were deemed essential tasks of the model. CONCLUSION A plausible logic model for a SM program designed for workers with disabling LBP stay at work was developed. The next step will be to assess its acceptability with potential users.
Collapse
Affiliation(s)
- Christian Longtin
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.,Center for Action in Work Disability Prevention and Rehabilitation (CAPRIT) affiliated with the Charles-Le Moyne - Saguenay-Lac-Saint-Jean Research Center on Health Innovations (CR-CSIS), Quebec, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Marie-France Coutu
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.,Center for Action in Work Disability Prevention and Rehabilitation (CAPRIT) affiliated with the Charles-Le Moyne - Saguenay-Lac-Saint-Jean Research Center on Health Innovations (CR-CSIS), Quebec, Canada
| |
Collapse
|
12
|
Using a Motion Sensor to Categorize Nonspecific Low Back Pain Patients: A Machine Learning Approach. SENSORS 2020; 20:s20123600. [PMID: 32604794 PMCID: PMC7348921 DOI: 10.3390/s20123600] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/14/2022]
Abstract
Nonspecific low back pain (NSLBP) constitutes a critical health challenge that impacts millions of people worldwide with devastating health and socioeconomic consequences. In today’s clinical settings, practitioners continue to follow conventional guidelines to categorize NSLBP patients based on subjective approaches, such as the STarT Back Screening Tool (SBST). This study aimed to develop a sensor-based machine learning model to classify NSLBP patients into different subgroups according to quantitative kinematic data, i.e., trunk motion and balance-related measures, in conjunction with STarT output. Specifically, inertial measurement units (IMU) were attached to the trunks of ninety-four patients while they performed repetitive trunk flexion/extension movements on a balance board at self-selected pace. Machine learning algorithms (support vector machine (SVM) and multi-layer perceptron (MLP)) were implemented for model development, and SBST results were used as ground truth. The results demonstrated that kinematic data could successfully be used to categorize patients into two main groups: high vs. low-medium risk. Accuracy levels of ~75% and 60% were achieved for SVM and MLP, respectively. Additionally, among a range of variables detailed herein, time-scaled IMU signals yielded the highest accuracy levels (i.e., ~75%). Our findings support the improvement and use of wearable systems in developing diagnostic and prognostic tools for various healthcare applications. This can facilitate development of an improved, cost-effective quantitative NSLBP assessment tool in clinical and home settings towards effective personalized rehabilitation.
Collapse
|
13
|
Iles R, Sheehan L, Munk K, Gosling C. Development and Pilot Assessment of the PACE Tool: Helping Case Managers Identify and Respond to Risk Factors in Workers' Compensation Case Management. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:167-182. [PMID: 31541425 DOI: 10.1007/s10926-019-09858-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The aim was to develop a tool to be applied by workers' compensation case managers to guide intervention and avoid delayed return to work. Methods The Plan of Action for a CasE (PACE) tool was developed based on a review of existing literature, focus groups with case managers and analysis of existing claims data. Combined with analysis of existing case manager practice, these sources were used to determine key constructs for inclusion in the tool to be aligned with the demands of case manager workload. Mapping of existing interventions was used to match risk identified by the tool with appropriate intervention. Results The final PACE tool consisted of 41 questions divided into Ready (worker), Set (employer) and Go (treating practitioner) categories. Questions in the tool were linked to appropriate case manager actions. Data collection was completed by case managers for 524 claims within the first 2 weeks of the claim being accepted. The most commonly identified risks for delayed RTW included both worker and employer expectations of RTW, as well as certification of capacity. Factor analysis identified two factors operating across the tool categories. Case managers reported benefits in using the tool, but reported it also increased their workload. Conclusions The PACE tool is a unique example of the implementation of risk identification in case management practice. It demonstrates that case managers are ideally placed to collect information to identify risk of delayed RTW. Future work will establish the impact of case-manager led intervention based on identified risks on outcomes for injured workers.
Collapse
Affiliation(s)
- Ross Iles
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia.
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Australia.
| | - Luke Sheehan
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia
| | - Karen Munk
- Employers Mutual Limited (EML), Sydney, Australia
| | - Cameron Gosling
- Department of Community Emergency Health and Paramedic Practice, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| |
Collapse
|
14
|
Shraim M, Cifuentes M, Willetts JL, Marucci-Wellman HR, Pransky G. Why does the adverse effect of inappropriate MRI for LBP vary by geographic location? An exploratory analysis. BMC Musculoskelet Disord 2019; 20:574. [PMID: 31785613 PMCID: PMC6885323 DOI: 10.1186/s12891-019-2964-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early magnetic resonance imaging (eMRI) for nonspecific low back pain (LBP) not adherent to clinical guidelines is linked with prolonged work disability. Although the prevalence of eMRI for occupational LBP varies substantially among states, it is unknown whether the risk of prolonged disability associated with eMRI varies according to individual and area-level characteristics. The aim was to explore whether the known risk of increased length of disability (LOD) associated with eMRI scanning not adherent to guidelines for occupational LBP varies according to patient and area-level characteristics, and the potential reasons for any observed variations. METHODS A retrospective cohort of 59,360 LBP cases from 49 states, filed between 2002 and 2008, and examined LOD as the outcome. LBP cases with at least 1 day of work disability were identified by reviewing indemnity service records and medical bills using a comprehensive list of codes from the International Classification of Diseases, Ninth Edition (ICD-9) indicating LBP or nonspecific back pain, excluding medically complicated cases. RESULTS We found significant between-state variations in the negative impact of eMRI on LOD ranging from 3.4 days in Tennessee to 14.8 days in New Hampshire. Higher negative impact of eMRI on LOD was mainly associated with female gender, state workers' compensation (WC) policy not limiting initial treating provider choice, higher state orthopedic surgeon density, and lower state MRI facility density. CONCLUSION State WC policies regulating selection of healthcare provider and structural factors affecting quality of medical care modify the impact of eMRI not adherent to guidelines. Targeted healthcare and work disability prevention interventions may improve work disability outcomes in patients with occupational LBP.
Collapse
Affiliation(s)
- Mujahed Shraim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, P.O.Box: 2713, Doha, Qatar.
| | | | | | | | - Glenn Pransky
- University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, USA
| |
Collapse
|
15
|
Nottidge BA, Odole AC, Odunaiya NA, Akpa MO, Fawole OI, Akinpelu AO. Development and structural validity of a Nigerian culture- and environment-friendly low back pain outcome measure: Ibadan Low Back Pain Disability Questionnaire. Ghana Med J 2019; 53:126-134. [PMID: 31481808 PMCID: PMC6697772 DOI: 10.4314/gmj.v53i2.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Low Back Pain (LBP) is the leading cause of disability globally. Standardized outcome measures for measuring LBP disability exist but none was developed with consideration for the Nigerian culture and environment. Objective This study was aimed to develop a Nigerian culture- and environment-friendly LBP scale, the Ibadan Low Back Pain Disability Questionnaire (ILBPDQ). Methods Items on ILBPDQ were devised from literature review, interview of patients (231 consecutively-sampled patients with chronic non-specific LBP) and 12 professionals experienced in LBP management and were contentvalidated. The first draft of the questionnaire underwent pretesting twice among individuals with chronic non-specific LBP (n=35 and 114 respectively), factor analysis and experts' reviews to produce the final version. Results The final scale comprised 18 items with a two-factor structure (common Activity of Daily Living [ADL] and culture-specific ADL). It has eigen value ≥ 1 and explained 60% of variance. Items on ILBPDQ covered important constructs relevant to an average Nigerian patient with LBP. Conclusion A scale for assessing disability in LBP is made available for use in Nigeria and similar populations. Funding None declared
Collapse
Affiliation(s)
- Bolanle A Nottidge
- Department of Physiotherapy, University of Uyo Teaching Hospital, Uyo, Akwa-Ibom State, Nigeria
| | - Adesola C Odole
- Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria
| | - Nse A Odunaiya
- Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria
| | - Matthew O Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Olufunmilayo I Fawole
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Aderonke O Akinpelu
- Department of Physiotherapy, University of Uyo Teaching Hospital, Uyo, Akwa-Ibom State, Nigeria.,Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria.,Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| |
Collapse
|
16
|
Theis KA, Steinweg A, Helmick CG, Courtney-Long E, Bolen JA, Lee R. Which one? What kind? How many? Types, causes, and prevalence of disability among U.S. adults. Disabil Health J 2019; 12:411-421. [PMID: 31000498 DOI: 10.1016/j.dhjo.2019.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/29/2018] [Accepted: 03/10/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Quantifying the number of people with and types of disabilities is helpful for medical, policy, and public health planning. OBJECTIVE/HYPOTHESIS To update prior estimates on types, prevalence, and main causes of disability among U.S. adults using the Survey of Income and Program Participation (SIPP) data. METHODS We used cross-sectional data from the SIPP 2008 Panel Wave 6 interviews collected May-August 2010. Analyses were restricted to non-institutionalized adults ages ≥18 years (n = 66,410). Disability was ascertained via five non-mutually exclusive components: 1) specific activity difficulties, 2) selected impairments, 3) use of an assistive aid, 4) household work limitations, and 5) paid work limitations. Prioritized main cause of disability was established for the 95% of respondents with a disability type eligible for health condition questions. We generated weighted population estimates (number and percentage, with 95% confidence intervals (CIs)), accounting for the complex sample survey design. RESULTS 50 million U.S. adults (21.8%) experienced a disability in 2010. Mobility-related activity limitations were the most prevalent disabilities across all five components. The most common main causes of disability were arthritis/rheumatism, 9.1 million (19.2%, 95% CI = 18.4-20.0) and back or spine problems, 8.9 million (18.6%, 95% CI = 17.9-19.3). CONCLUSIONS A growing population with disabilities has the potential to put considerable and unsustainable demand on medical, public health, and senior service systems. Strengthening clinical community linkages and expanding the availability of existing evidence-based public health interventions to prevent, delay, and mitigate the effects of disability could improve health and outcomes for people with disabilities.
Collapse
Affiliation(s)
- Kristina A Theis
- Division of Population Health, Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy, Atlanta, GA, 30341, USA.
| | - Amy Steinweg
- Social, Economic, and Housing Statistics Division, U.S. Census Bureau, 4600 Silver Hill Road, Washington, DC, 20233, USA.
| | - Charles G Helmick
- Division of Population Health, Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy, Atlanta, GA, 30341, USA.
| | - Elizabeth Courtney-Long
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), USA.
| | - Julie A Bolen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), USA.
| | - Robin Lee
- Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention (CDC), USA.
| |
Collapse
|
17
|
Heinrich M, Steiner S, Bauer CM. The effect of visual feedback on people suffering from chronic back and neck pain – a systematic review. Physiother Theory Pract 2019; 36:1220-1231. [DOI: 10.1080/09593985.2019.1571140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Martin Heinrich
- Institute of Physiotherapy, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Simon Steiner
- Institute of Physiotherapy, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Christoph Michael Bauer
- Institute of Physiotherapy, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| |
Collapse
|
18
|
The Use of Negative Acceleration as Accessory Force during Lifting. Adv Orthop 2018; 2018:9164590. [PMID: 30631604 PMCID: PMC6304531 DOI: 10.1155/2018/9164590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 07/13/2018] [Accepted: 10/03/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Injury associated with lifting, especially low back injury, is a big problem in industry that accounts for loss of work and high medical expenses. Studies of biomechanics of lifting provide a basis for optimization of lifting. The aim of the study was to further investigate the role of the upward force due to negative acceleration during a lift. METHODS Nine healthy subjects lifted an empty box and a box with additional load of 10, 20, and 25 lb. Kinematic data were recorded during the lifts and accelerations were calculated, and angular positions of the trunk and knee were obtained during the lifting when negative accelerations were used. RESULTS Negative acceleration assisted the quadriceps when the thighs were at approximately 90° and the hips when the trunk was rotating toward standing position. Negative acceleration was present during lifts of different loads. CONCLUSION The outcome of the study suggests that enhancing the use of negative acceleration could be a strategy to improve the quality of lifting and minimize a probability of low back injury.
Collapse
|
19
|
Vaičienė G, Berškienė K, Slapsinskaite A, Mauricienė V, Razon S. Not only static: Stabilization manoeuvres in dynamic exercises - A pilot study. PLoS One 2018; 13:e0201017. [PMID: 30089127 PMCID: PMC6082523 DOI: 10.1371/journal.pone.0201017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/06/2018] [Indexed: 12/19/2022] Open
Abstract
This study examined characteristics of trunk muscles electrical activity in young adults performed in the course of static and dynamic trunk muscles strengthening exercises using different lumbar spine stabilization manoeuvres. Twenty young adults (Mage = 25.5 SD = 2.91) participated in this study. Of the 20, 11 subjects (5 males and 6 females) reported no history of pain, 9 subjects (5 males and 4 females) reported lower back pain (LBP) within the last three months. Subjects performed lumbar spine stabilization manoeuvres (abdominal bracing (AB) and abdominal hollowing (AH)) with static and dynamic abdominal muscles strengthening exercises (i.e., plank, side-bridges, and curl-ups). Noraxon Telemyo twelve channel electromyography device (Noraxon USA, Inc.) was used to record EMG data from rectus abdominal muscle (RA), external oblique muscles (EO), internal oblique muscles (IO), and erector spine muscles (ES). In static exercises such as side-bridge exercise, significantly higher RA muscle electrical activity was recorded with AB manoeuvre compared to AH manoeuvre both on the right side and left side respectively (Z = -2.17; p = 0.03; Z = 3.40; p = 0.001). In dynamic exercises such as curl-up exercise, during the lifting phase, median value of RA muscle activity with AB was significantly higher than with AH (Z = -2.315; p = 0.021). Median value of IO muscles activity with AH was significantly higher than with AB (Z = -3.230; p = 0.001). Our findings indicated that although surface muscles are more activated with AB manoeuvre exercises, deep abdominal muscles are more activated in exercises with AH manoeuvre. These findings can help practitioners design interventions to integrate AH manoeuvre for benefiting persons with lumbar instability.
Collapse
Affiliation(s)
- Giedrė Vaičienė
- Institute of Sports, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Kristina Berškienė
- Institute of Sports, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Agne Slapsinskaite
- Institute of Sports, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
- Health Research Institute, LUHS, Kaunas, Lithuania
- * E-mail:
| | - Vilma Mauricienė
- Institute of Sports, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Selen Razon
- Department of Kinesiology, West Chester University, West Chester, PA, United States of America
| |
Collapse
|
20
|
Chance-Larsen F, Chance-Larsen K, Divanoglou A, Baird A. The use of an e-learning module on return to work advice for physiotherapists - A prospective cohort study. Physiother Theory Pract 2018; 36:267-275. [PMID: 29924673 DOI: 10.1080/09593985.2018.1485193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Nonspecific low back pain (LBP) can progress to chronic disability and prolonged absence from work. Despite clinical and professional guidelines, physiotherapists often fail to address return to work outcomes. Aims: The aim of this exploratory study was to determine whether an e-learning resource tailored to physiotherapy practice could affect physiotherapists' attitudes and beliefs regarding return to work advice for their patients. Design: A prospective interventional cohort study (pilot). Methods: Participants were recruited via the Chartered Society of Physiotherapy website. Responses on a clinical vignette, the Health Care Providers' Pain and Impairment Scale (HC-Pairs), and the Behavioral Constructs Questionnaire (BCQ) were collected online at baseline (Q1) and 2-months post-intervention (Q2). Results: Fifty-four physiotherapists completed Q1 and the response rate for Q2 was 44/54 (81%). Changes in the degree of agreement with guidelines indicated that the intervention made an impact on respondents (kappa 0.345; p = 0.003). HC-Pairs and BCQ results showed a nonstatistically significant trend toward the target behavior. Conclusions: There is a need for interventions to improve adherence with advice for return to work following nonspecific LBP. An e-learning tool for physiotherapists on advising patients regarding return to work has potential to positively affect self-reported clinical behavior.
Collapse
Affiliation(s)
- Fiona Chance-Larsen
- Employee Health & Wellbeing Service, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Anestis Divanoglou
- Department of Physiotherapy, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Andrew Baird
- Centre for Psychological Research, University of Derby, Derby, UK
| |
Collapse
|
21
|
The Global Spine Care Initiative: a narrative review of psychological and social issues in back pain in low- and middle-income communities. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:828-837. [PMID: 29374779 DOI: 10.1007/s00586-017-5434-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this review was to describe psychological and social factors associated with low back pain that could be applied in spine care programs in medically underserved areas and low- and middle-income countries. METHODS We performed a narrative review of cohort, cross-sectional, qualitative and mixed methods studies investigating adults with low back pain using Medline and PubMed were searched from January 2000 to June 2015. Eligible studies had at least one of the following outcomes: psychological, social, psychosocial, or cultural/ethnicity factors. Studies met the following criteria: (1) English language, (2) published in peer-reviewed journal, (3) adults with spinal disorders, (4) included treatment, symptom management or prevention. RESULTS Out of 58 studies, 29 were included in this review. There are few studies that have evaluated psychological and social factors associated with back pain in low- and middle-income communities, therefore, adapting recommendations from other regions may be needed until further studies can be achieved. CONCLUSION Psychological and social factors are important components to addressing low back pain and health care providers play an important role in empowering patients to take control of their spinal health outcomes. Patients should be included in negotiating their spinal treatment and establishing treatment goals through careful listening, reassurance, and information providing by the health care provider. Instruments need to be developed for people with low literacy in medically underserved areas and low- and middle-income countries, especially where psychological and social factors may be difficult to detect and are poorly addressed. These slides can be retrieved under Electronic Supplementary Material.
Collapse
|
22
|
Abstract
This study examined the relation between return to work and the maintenance of treatment gains made over the course of a rehabilitation intervention. The study sample consisted of 110 individuals who had sustained whiplash injuries in rear collision motor vehicle accidents and were work-disabled at the time of enrolment in the study. Participants completed pre- and post-treatment measures of pain severity, disability, cervical range of motion, depression, posttraumatic stress symptoms, and catastrophizing. Pain severity was assessed again at 1-year follow-up. At 1-year follow-up, 73 participants had returned to work and 37 remained work-disabled. Analyses revealed that participants who returned to work were more likely to maintain treatment gains (77.5%) than participants who remained work-disabled (48%), χ = 6.3, P < 0.01. The results of a regression analysis revealed that the relation between return to work and the maintenance of treatment gains remained significant (β = 0.30, P < 0.01), even when controlling for potential confounders such as pain severity, restricted range of motion, depression, and pain catastrophizing. The Discussion addresses the processes by which prolonged work-disability might contribute to the failure to maintain treatment gains. Important knowledge gaps still remain concerning the individual, workplace, and system variables that might play a role in whether or not the gains made in the rehabilitation of whiplash injury are maintained. Clinical implications of the findings are also addressed.
Collapse
|
23
|
Arden K, Fatoye F, Yeowell G. Evaluation of a rolling rehabilitation programme for patients with non-specific low back pain in primary care: an observational cohort study. J Eval Clin Pract 2017; 23:272-278. [PMID: 27436337 DOI: 10.1111/jep.12595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 01/26/2023]
Abstract
AIM The Back Rehabilitation Programme (BRP) is a group exercise programme for patients with non-specific low back pain (NSLBP) that combines cognitive behavioural therapy principles and therapeutic exercise to empower patients to self-manage their condition. Poor attendance and high attrition rates resulted in changes to the format of the programme from a standard sequential approach to a continual rolling approach. The aim of this study was to evaluate the effectiveness of this new approach on patient outcomes and its impact on attendance rates. METHOD A service evaluation, using a retrospective, observational cohort design, of all patients with NSLBP who attended the BRP during a 12-month period was undertaken. Outcome measures used were as follows: Bournemouth Questionnaire (BQ); fitness tests: sit to stand test, step test and walk test (taken at baseline and post programme); and attendance (taken post programme). RESULTS Of the patients, 56% had an improved BQ score ≥ 47%, indicating a clinically significant change. Inferential testing showed statistically significant improvements in the BQ and all three fitness tests post programme (P< 0.0001). In total, 62 patients attended the rolling BRP, and 41 patients (66%) completed. Thus, the percentage of patients completing the new programme had doubled compared with the original standard programme. CONCLUSION Patients with NSLBP who attended the continual rolling BRP show clinical and statistical improvements. The rolling format also appeared to enhance patient attendance. As such, the rolling BRP should be considered by practitioners as an effective management strategy when treating patients with NSLBP.
Collapse
Affiliation(s)
- Kathleen Arden
- Musculoskeletal Clinical Assessment and Treatment Service, Bridgewater Community Healthcare NHS Foundation Trust, Lancashire, UK
| | | | | |
Collapse
|
24
|
Beneciuk JM, Hill JC, Campbell P, Afolabi E, George SZ, Dunn KM, Foster NE. Identifying Treatment Effect Modifiers in the STarT Back Trial: A Secondary Analysis. THE JOURNAL OF PAIN 2016; 18:54-65. [PMID: 27765643 DOI: 10.1016/j.jpain.2016.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/16/2016] [Accepted: 10/05/2016] [Indexed: 12/28/2022]
Abstract
Identification of patient characteristics influencing treatment outcomes is a top low back pain (LBP) research priority. Results from the STarT Back trial support the effectiveness of prognostic stratified care for LBP compared with current best care, however, patient characteristics associated with treatment response have not yet been explored. The purpose of this secondary analysis was to identify treatment effect modifiers within the STarT Back trial at 4-month follow-up (n = 688). Treatment response was dichotomized using back-specific physical disability measured using the Roland-Morris Disability Questionnaire (≥7). Candidate modifiers were identified using previous literature and evaluated using logistic regression with statistical interaction terms to provide preliminary evidence of treatment effect modification. Socioeconomic status (SES) was identified as an effect modifier for disability outcomes (odds ratio [OR] = 1.71, P = .028). High SES patients receiving prognostic stratified care were 2.5 times less likely to have a poor outcome compared with low SES patients receiving best current care (OR = .40, P = .006). Education level (OR = 1.33, P = .109) and number of pain medications (OR = .64, P = .140) met our criteria for effect modification with weaker evidence (.20 > P ≥ .05). These findings provide preliminary evidence for SES, education, and number of pain medications as treatment effect modifiers of prognostic stratified care delivered in the STarT Back Trial. PERSPECTIVE This analysis provides preliminary exploratory findings about the characteristics of patients who might least likely benefit from targeted treatment using prognostic stratified care for LBP.
Collapse
Affiliation(s)
- Jason M Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, Florida; Brooks Rehabilitation-College of Public Health and Health Professions (University of Florida) Research Collaboration, University of Florida, Gainesville, Florida.
| | - Jonathan C Hill
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Paul Campbell
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Ebenezer Afolabi
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Steven Z George
- Department of Physical Therapy, University of Florida, Gainesville, Florida; Brooks Rehabilitation-College of Public Health and Health Professions (University of Florida) Research Collaboration, University of Florida, Gainesville, Florida
| | - Kate M Dunn
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
| |
Collapse
|
25
|
Lag Times in Reporting Injuries, Receiving Medical Care, and Missing Work: Associations With the Length of Work Disability in Occupational Back Injuries. J Occup Environ Med 2016; 58:53-60. [PMID: 26445030 PMCID: PMC4697957 DOI: 10.1097/jom.0000000000000591] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study is to examine the associations between lag times following occupational low back injury and the length of work disability.
Collapse
|
26
|
Coenen P, Douwes M, van den Heuvel S, Bosch T. Towards exposure limits for working postures and musculoskeletal symptoms - a prospective cohort study. ERGONOMICS 2016; 59:1182-1192. [PMID: 26678353 DOI: 10.1080/00140139.2015.1130862] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Occupational postures are considered to be an important group of risk factors for musculoskeletal pain. However, the exposure-outcome association is not clear yet. Therefore, we aimed to determine the exposure-outcome association of working postures and musculoskeletal symptoms. Also, we aimed to establish exposure limits for working postures. In a prospective cohort study among 789 workers, intensity, frequency and duration of postures were assessed at baseline using observations. Musculoskeletal pain was assessed cross-sectionally and longitudinally and associations of postures and pain were addressed using logistic regression analyses. Cut-off points were estimated based on ROC-curve analyses. Associations were found for kneeling/crouching and low-back pain, neck flexion and rotation and neck pain, trunk flexion and low-back pain, and arm elevation and neck and shoulder pain. The results provide insight into exposure-outcome relations between working postures and musculoskeletal symptoms as well as evidence-based working posture exposure limits that can be used in future guidelines and risk assessment tools. Practitioner Summary: Our study gives insight into exposure-outcome associations of working postures and musculoskeletal symptoms (kneeling/crouching and low-back pain, neck flexion/rotation and neck pain, trunk flexion and low-back pain, and arm elevation and neck and shoulder pain). Results furthermore deliver evidence-based postural exposure limits that can be used in guidelines and risk assessments.
Collapse
Affiliation(s)
- Pieter Coenen
- a School of Physiotherapy and Exercise Science , Curtin University , Perth , Australia
- b Faculty of Human Movement Sciences, Research Institute MOVE , VU University Amsterdam , Amsterdam , The Netherlands
| | | | | | | |
Collapse
|
27
|
Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res 2016; 9:457-67. [PMID: 27418853 PMCID: PMC4935027 DOI: 10.2147/jpr.s105892] [Citation(s) in RCA: 516] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Chronic pain (CP) seriously affects the patient’s daily activities and quality of life, but few studies on CP have considered its effects on the patient’s social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient’s daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient’s life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives.
Collapse
Affiliation(s)
- María Dueñas
- Nursing Faculty "Salus Infirmorum", The Observatory of Pain, University of Cádiz, Cádiz, Spain
| | - Begoña Ojeda
- Preventive Medicine and Public Health Area, The Observatory of Pain, University of Cádiz, Cádiz, Spain
| | - Alejandro Salazar
- Preventive Medicine and Public Health Area, The Observatory of Pain, University of Cádiz, Cádiz, Spain
| | - Juan Antonio Mico
- Department of Neuroscience, Pharmacology, and Psychiatry, CIBER of Mental Health, CIBERSAM, Institute of Health Carlos III, University of Cádiz, Cádiz, Spain
| | - Inmaculada Failde
- Preventive Medicine and Public Health Area, The Observatory of Pain, University of Cádiz, Cádiz, Spain
| |
Collapse
|
28
|
Bailly F, Foltz V, Rozenberg S, Fautrel B, Gossec L. The impact of chronic low back pain is partly related to loss of social role: A qualitative study. Joint Bone Spine 2015; 82:437-41. [DOI: 10.1016/j.jbspin.2015.02.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
|
29
|
Herr RM, Bosch JA, Loerbroks A, van Vianen AEM, Jarczok MN, Fischer JE, Schmidt B. Three job stress models and their relationship with musculoskeletal pain in blue- and white-collar workers. J Psychosom Res 2015; 79:340-7. [PMID: 26526306 DOI: 10.1016/j.jpsychores.2015.08.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/31/2015] [Accepted: 08/02/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Musculoskeletal pain has been found to co-occur with psychosocial job stress. However, different conceptualizations of job stress exist, each emphasizing different aspects of the work environment, and it is unknown which of these aspects show the strongest associations with musculoskeletal pain. Further, these associations may differ for white-collar vs. blue-collar job types, but this has not been tested. The present study examined the independent and combined contributions of Effort-RewardImbalance (ERI), Job-Demand-Control (JDC) and Organizational Justice (OJ) to musculoskeletal pain symptoms among white- and blue-collar workers. METHODS Participants of a cross-sectional study (n=1634) completed validated questionnaires measuring ERI, JDC, and OJ, and reported the frequency of pain during the previous year at four anatomical locations (lower back, neck or shoulder, arms and hands, and knees/feet). Pain reports were summarized into a single musculoskeletal symptom score (MSS). Analyses were stratified for white- and blue-collar workers. RESULTS Among white-collar workers, ERI and OJ were independently associated with MSS. In addition to these additive effects, significant 2-way and 3-way interactions indicated a synergistic effect of job stressors in relation to reported pain. In blue-collar workers, ERI and JDC independently associated with MSS, and a significant 3-way interaction was observed showing that the combination of job stressors exceeded an additive effect. CONCLUSION ERI influences pain symptoms in both occupational groups. OJ was independent significant predictor only among white-collar workers, whereas JDC had additive predictive utility exclusively among blue-collar workers. Simultaneous exposure to multiple job stress factors appeared to synergize pain symptom reporting.
Collapse
Affiliation(s)
- Raphael M Herr
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jos A Bosch
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Adrian Loerbroks
- Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Annelies E M van Vianen
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc N Jarczok
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Joachim E Fischer
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Burkhard Schmidt
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
30
|
Supervisors' Strategies to Facilitate Work Functioning among Employees with Musculoskeletal Complaints: A Focus Group Study. ScientificWorldJournal 2015; 2015:865628. [PMID: 26380370 PMCID: PMC4562179 DOI: 10.1155/2015/865628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 03/04/2015] [Indexed: 11/17/2022] Open
Abstract
AIM To explore what strategies the supervisors found beneficial to prevent or reduce sickness absence among employees with musculoskeletal complaints. METHODS Five focus groups were conducted and 26 supervisors from health and social sector participated. Commonly used strategies to prevent sickness absence and interdisciplinary cooperation in this work were discussed in the focus groups. Systematic text condensation was used to analyse the data. RESULTS The supervisors described five strategies for sick leave management: (1) promoting well-being and a healthy working environment, (2) providing early support and adjustments, (3) making employees more responsible, (4) using confrontational strategies in relation to employees on long-term sick leave, and (5) cooperation with general practitioners (GPs). CONCLUSIONS Strategies of promoting a healthy working environment and facilitating early return to work were utilised in the follow-up of employees with musculoskeletal complaints. Supportive strategies were found most useful especially in the early phases, while finding a balance between being supportive, on one side, and confronting the employee, on the other, was endeavoured in cases of recurrent or long-term sick leave. Further, the supervisors requested a closer cooperation with the GPs, which they believed would facilitate return to work.
Collapse
|
31
|
Schaafsma FG, Anema JR, van der Beek AJ. Back pain: Prevention and management in the workplace. Best Pract Res Clin Rheumatol 2015; 29:483-94. [PMID: 26612243 DOI: 10.1016/j.berh.2015.04.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite all the efforts in studying work-related risk factors for low back pain (LBP), interventions targeting these risk factors to prevent LBP have no proven cost-effectiveness. Even with adequate implementation strategies for these interventions on group level, these did not result in the reduction of incident LBP. Physical exercise, however, does have a primary preventive effect on LBP. For secondary prevention, it seems that there are more opportunities to cost-effectively intervene in reducing the risk of long-term sickness absence due to LBP. Starting at the earliest moment possible with proper assessment of risk factors for long-term sickness absence related to the individual, the underlying mechanisms of the LBP, and also factors related to the workplace by a well-trained clinician, may increase the potential of effective return to work (RTW) management. More research on how to overcome barriers in the uptake of these effective interventions in relation to policy-specific environments, and with regard to proper financing of RTW management is necessary.
Collapse
Affiliation(s)
- Frederieke G Schaafsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Research Centre for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.
| | - Johannes R Anema
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Research Centre for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Research Centre for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands; Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
32
|
Gebauer S, Scherrer JF, Salas J, Burge S, Schneider FD. Disability and disability benefit seeking in chronic low back pain. Occup Med (Lond) 2015; 65:309-16. [DOI: 10.1093/occmed/kqv012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
33
|
Improving work outcomes of dysthymia (persistent depressive disorder) in an employed population. Gen Hosp Psychiatry 2015; 37:352-9. [PMID: 25892151 PMCID: PMC4457606 DOI: 10.1016/j.genhosppsych.2015.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To test the effectiveness of a work-focused intervention (WFI) on the work outcomes of employed adults with dysthymia. METHOD This subgroup analysis from a randomized controlled trial compares an initial sample of 167 employees (age: ≥45 years), screened for dysthymia using the PC-SAD without current major depressive disorder randomized to WFI (n=85) or usual care (UC) (n=82). Study sites included 19 employers and five additional organizations. Telephone-based WFI counseling (eight, twice monthly 50-min sessions) provided work coaching and modification, care coordination and cognitive behavioral therapy. Adjusted mixed effects models compared the WFI vs. UC group preintervention to 4-month postintervention change in at-work limitations measured by the Work Limitations Questionnaire. Secondary outcome analysis compared the change in self-reported absences and depression symptom severity (Patient Health Questionnaire PHQ-9 scores). RESULTS Work productivity loss scores improved 43.0% in the WFI group vs. 4.8% in UC (difference in change: P<.001). Absence days declined by 58.3% in WFI vs. 0.0% in UC (difference in change: P=.09). Mean PHQ-9 depression symptom severity declined 44.2% in WFI vs. 5.3% in UC (difference in change: P<.001). CONCLUSION At 4 months, the WFI was more effective than UC on two of the three outcomes. It could be an important mental and functional health improvement resource for the employed dysthymic population.
Collapse
|
34
|
Lee J, Nussbaum MA, Kyung G. Effects of work experience on fatigue-induced biomechanical changes during repetitive asymmetric lifts/lowers. ERGONOMICS 2014; 57:1875-1885. [PMID: 25216272 DOI: 10.1080/00140139.2014.957733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Repetitive lifting/lowering is associated with an increased risk of work-related low back disorders (WRLBDs), and fatigue may exacerbate such risk. Work methods used by experienced workers are potential models for developing worker training to reduce WRLBDs, though whether experience modifies the effects of fatigue on WRLBD risk is largely unknown. Here, six novices and six experienced workers completed 185 cycles of repetitive, asymmetric lifts/lowers. Physical demands, whole-body balance and torso movement stability were assessed using torso kinematics/kinetics, linear/angular momenta and Lyapunov exponents, respectively. Several fatigue-induced changes in movement strategies were evident. Novices decreased and experienced workers increased peak lumbar moments post-fatigue, suggesting lower WRLBD risks among the former in terms of torso kinetics. Other than lumbar moments, though, fatigue substantially reduced group-level differences in torso twisting velocities and accelerations. Post-fatigue movement strategies of experienced workers thus did not appear to be advantageous in terms of WRLBD risk.
Collapse
Affiliation(s)
- Jungyong Lee
- a Ergonomics Team, Hyundai Motor Company , Gyeonggi-Do , Republic of Korea
| | | | | |
Collapse
|
35
|
Ivanova JI, Birnbaum HG, Kantor E, Schiller M, Swindle RW. Duloxetine use in employees with low back pain: treatment patterns and direct and indirect costs. PAIN MEDICINE 2014; 15:1015-26. [PMID: 24529260 DOI: 10.1111/pme.12362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The study aims to examine real-world effects of duloxetine treatment for low back pain (LBP). METHODS The study identified employees with ≥1 LBP diagnosis and ≥1 duloxetine prescription within a year after LBP diagnosis from a privately insured claims database (2004-2007). Duloxetine-treated employees were propensity score matched to employees initiating another pharmacological/noninvasive treatment in the same month from LBP diagnosis. Treatment patterns and costs were compared over the 6 months following treatment initiation. RESULTS Relative to controls, duloxetine-treated employees (N = 753) had significantly lower rates of other pharmacological/noninvasive therapies and a similar LBP surgery rate (1.7% vs 2.8%, P = 0.1573). Duloxetine-treated employees, despite higher pharmacy costs, had similar direct (health care) costs ($4,935 vs $5,649, P = 0.2662), and significantly lower indirect (workloss) costs ($1,723 vs $2,198, P = 0.0036). CONCLUSIONS Duloxetine treatment in LBP employees was associated with reduced rates of many nonsurgical therapies and lower indirect costs. The findings are limited by the observational study design and unmeasured potential confounders.
Collapse
|
36
|
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.
Collapse
Affiliation(s)
- Iuliana Nastasia
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) , Montreal, Quebec , Canada and
| | | | | |
Collapse
|
37
|
Schultz IZ, Chlebak CM. Disability and Impairment in Medicolegal Settings: Pain Disability Controversies. HANDBOOKS IN HEALTH, WORK, AND DISABILITY 2014. [DOI: 10.1007/978-1-4939-0612-3_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
38
|
Johnston V, Shaw WS. Helping workers help themselves: empowering physiotherapy clients to manage musculoskeletal problems at work. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x13y.0000000087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
39
|
Shaw WS, Campbell P, Nelson CC, Main CJ, Linton SJ. Effects of workplace, family and cultural influences on low back pain: What opportunities exist to address social factors in general consultations? Best Pract Res Clin Rheumatol 2013; 27:637-48. [DOI: 10.1016/j.berh.2013.09.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
40
|
Early Intervention with Compensated Lower Back-Injured Workers at Risk for Work Disability: Fixed versus Flexible Approach. PSYCHOLOGICAL INJURY & LAW 2013. [DOI: 10.1007/s12207-013-9165-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
41
|
Shaw WS, Chin EH, Nelson CC, Reme SE, Woiszwillo MJ, Verma SK. What circumstances prompt a workplace discussion in medical evaluations for back pain? JOURNAL OF OCCUPATIONAL REHABILITATION 2013; 23:125-34. [PMID: 23054227 DOI: 10.1007/s10926-012-9392-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE To determine how frequently workplace topics emerge in the interactions between patients and providers in an evaluation for low back pain (LBP) and to determine its association with patient and provider characteristics. METHODS Adults with work-related LBP (N = 97; 64 % male; median age = 38) completed a demographic questionnaire and a survey of disability risk factors, then agreed to audio-taping of their visits with a participating occupational healthcare provider (n = 14). Utterance-level verbal exchanges were categorized by trained coders using the Roter interaction analysis system. In addition, coders flagged any instance of workplace discussion between patients and providers. RESULTS Workplace discussions occurred in 51 % of visits, and the most frequent topic was physical job demands. Workplace discussions were more frequent among the oldest and youngest patients and when patients were seen by providers who were more patient-centered and made more efforts to establish patient rapport and engagement. However, patients reporting numerous disability risk factors and workplace concerns in the pre-visit questionnaire were no more likely to discuss workplace topics with their providers (p > 0.05). Only the patient-centered orientations of providers and patients remained statistically significant predictors in multivariate modeling (p < 0.05). CONCLUSIONS Workplace discussions are facilitated by a patient-centered orientation and by efforts to establish patient engagement and rapport, but workplace discussions are no more frequent among patients with the most significant workplace concerns. Screening questionnaires and other assessment tools may be helpful to foster workplace discussions to overcome possible barriers for returning to work.
Collapse
Affiliation(s)
- William S Shaw
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA.
| | | | | | | | | | | |
Collapse
|
42
|
Iles RA, Wyatt M, Pransky G. Multi-faceted case management: reducing compensation costs of musculoskeletal work injuries in Australia. JOURNAL OF OCCUPATIONAL REHABILITATION 2012; 22:478-88. [PMID: 22466434 DOI: 10.1007/s10926-012-9364-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES This study aimed to determine whether a multi-faceted model of management of work related musculoskeletal disorders reduced compensation claim costs and days of compensation for injured workers. METHODS An intervention including early reporting, employee centred case management and removal of barriers to return to work was instituted in 16 selected companies with a combined remuneration over $337 million. Outcomes were evaluated by an administrative dataset from the Victorian WorkCover Authority database. A 'quasi experimental' pre-post design was employed with 492 matched companies without the intervention used as a control group and an average of 21 months of post-intervention follow-up. Primary outcomes were average number of days of compensation and average cost of claims. Secondary outcomes were total medical costs and weekly benefits paid. RESULTS Information on 3,312 claims was analysed. In companies where the intervention was introduced the average cost of claims was reduced from $6,019 to $3,913 (estimated difference $2,329, 95 % CI $1,318-$3,340) and the number of days of compensation decreased from 33.5 to 14.1 (HR 0.77, 95 % CI 0.67-0.88). Medical costs and weekly benefits costs were also lower after the intervention (p < 0.05). Reduction in claims costs were noted across industry types, injury location and most employer sizes. CONCLUSIONS The model of claims management investigated was effective in reducing the number of days of compensation, total claim costs, total medical costs and the amount paid in weekly benefits. Further research should investigate whether the intervention improves non-financial outcomes in the return to work process.
Collapse
Affiliation(s)
- Ross Anthony Iles
- Department of Physiotherapy, La Trobe University, Bundoora, Melbourne, VIC, 3196, Australia.
| | | | | |
Collapse
|
43
|
Solovieva S, Pehkonen I, Kausto J, Miranda H, Shiri R, Kauppinen T, Heliövaara M, Burdorf A, Husgafvel-Pursiainen K, Viikari-Juntura E. Development and validation of a job exposure matrix for physical risk factors in low back pain. PLoS One 2012; 7:e48680. [PMID: 23152793 PMCID: PMC3495969 DOI: 10.1371/journal.pone.0048680] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 10/01/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim was to construct and validate a gender-specific job exposure matrix (JEM) for physical exposures to be used in epidemiological studies of low back pain (LBP). MATERIALS AND METHODS We utilized two large Finnish population surveys, one to construct the JEM and another to test matrix validity. The exposure axis of the matrix included exposures relevant to LBP (heavy physical work, heavy lifting, awkward trunk posture and whole body vibration) and exposures that increase the biomechanical load on the low back (arm elevation) or those that in combination with other known risk factors could be related to LBP (kneeling or squatting). Job titles with similar work tasks and exposures were grouped. Exposure information was based on face-to-face interviews. Validity of the matrix was explored by comparing the JEM (group-based) binary measures with individual-based measures. The predictive validity of the matrix against LBP was evaluated by comparing the associations of the group-based (JEM) exposures with those of individual-based exposures. RESULTS The matrix includes 348 job titles, representing 81% of all Finnish job titles in the early 2000s. The specificity of the constructed matrix was good, especially in women. The validity measured with kappa-statistic ranged from good to poor, being fair for most exposures. In men, all group-based (JEM) exposures were statistically significantly associated with one-month prevalence of LBP. In women, four out of six group-based exposures showed an association with LBP. CONCLUSIONS The gender-specific JEM for physical exposures showed relatively high specificity without compromising sensitivity. The matrix can therefore be considered as a valid instrument for exposure assessment in large-scale epidemiological studies, when more precise but more labour-intensive methods are not feasible. Although the matrix was based on Finnish data we foresee that it could be applicable, with some modifications, in other countries with a similar level of technology.
Collapse
Affiliation(s)
- Svetlana Solovieva
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Vidal J, Borràs PA, Ponseti FJ, Cantallops J, Ortega FB, Palou P. Effects of a postural education program on school backpack habits related to low back pain in children. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:782-7. [PMID: 23143093 DOI: 10.1007/s00586-012-2558-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/28/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE Population based studies have demonstrated that children and adolescents often complain of low back pain. A group-randomized controlled trial was carried out to investigate the effects of a postural education program on school backpack habits related to low back pain in children aged 10-12 year. METHODS The study sample included 137 children aged 10.7 years (SD = 0.672). Six classes from two primary schools were randomly allocated into experimental group (EG) (N = 63) or control group (CG) (N = 74). The EG received a postural education program over 6 weeks consisting of six sessions, while the CG followed the usual school curriculum. A questionnaire was fulfilled by the participants at pre-test, post-test, and 3 months after the intervention finished. The outcomes collected were: (1) try to load the minimum weight possible, (2) carry school backpack on two shoulders, (3) belief that school backpack weight does not affect to the back, and (4) the use of locker or something similar at school. A sum score was computed from the four items. RESULTS Single healthy items mostly improved after the intervention and remained improved after 3-month follow-up in EG, while no substantial changes were observed in the CG. Healthy backpack use habits score was significantly increased at post-test compared to baseline in the EG (P < 0.000), and remained significantly increased after 3-month, compared to baseline (P = 0.001). No significant changes were observed in the CG (P > 0.2). CONCLUSIONS The present study findings confirm that children are able to learn healthy backpack habits which might prevent future low back pain.
Collapse
Affiliation(s)
- Josep Vidal
- Exercise and Sports Science Research Group, University of Balearic Islands, Ctra. Valldemossa km.7'5, Edifici Guillem Cifre de Colonya, Palma of Majorca 07122, Spain.
| | | | | | | | | | | |
Collapse
|
45
|
Campbell P, Wynne-Jones G, Muller S, Dunn KM. The influence of employment social support for risk and prognosis in nonspecific back pain: a systematic review and critical synthesis. Int Arch Occup Environ Health 2012; 86:119-37. [PMID: 22875173 PMCID: PMC3555241 DOI: 10.1007/s00420-012-0804-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 07/24/2012] [Indexed: 12/02/2022]
Abstract
Purpose To examine the influence of employment social support type (e.g. co-worker, supervisor, general support) on risk of occurrence of low back pain, and prognosis (e.g. recovery, return to work status) for those who have low back pain. Methods Systematic search of seven databases (MEDLINE, Embase, PsychINFO, CINAHL, IBSS, AMED and BNI) for prospective or case–control studies reporting findings on employment social support in populations with nonspecific back pain. Data extraction and quality assessment were carried out on included studies. A systematic critical synthesis was carried out on extracted data. Results Thirty-two articles were included that describe 46 findings on the effect of employment social support on risk of and prognosis of back pain. Findings show that there is no effect of co-worker, supervisor or general work support on risk of new onset back pain. Weak effects of employment support were found for recovery and return to work outcomes; greater levels of co-worker support and general work support were found to be associated with less time to recovery or return to work. Conclusions The evidence suggests that the association between employment support and prognosis may be subject to influence from wider concepts related to the employment context. This review discusses these wider issues and offers directions for future research.
Collapse
Affiliation(s)
- Paul Campbell
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK.
| | | | | | | |
Collapse
|
46
|
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.
Collapse
Affiliation(s)
- Carol Coole
- Faculty of Medicine and Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
| | | | | |
Collapse
|
47
|
Impact of a work-focused intervention on the productivity and symptoms of employees with depression. J Occup Environ Med 2012; 54:128-35. [PMID: 22252528 DOI: 10.1097/jom.0b013e31824409d8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test a new program's effectiveness in reducing depression's work burden. METHODS A brief telephonic program to improve work functioning was tested in an early-stage randomized controlled trial involving 79 Maine State Government employees who were screened in for depression and at-work limitations (treatment group = 59; usual care group = 27). Group differences in baseline to follow-up change scores on the Work Limitations Questionnaire (WLQ), WLQ Absence Module, and Patient Health Questionnaire (PHQ)-9 depression severity scale were tested with analysis of covariance. RESULTS Although there were no baseline group differences (P ≥ 0.05), by follow-up, the treatment group had significantly better scores on every outcome and differences in the longitudinal changes were all statistically significant (P = 0.0.27 to 0.0001). CONCLUSIONS The new program was superior to usual care. The estimated productivity cost savings is $6041.70 per participant annually.
Collapse
|
48
|
Whitehurst DGT, Bryan S, Lewis M, Hill J, Hay EM. Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups. Ann Rheum Dis 2012; 71:1796-802. [PMID: 22492783 PMCID: PMC3465856 DOI: 10.1136/annrheumdis-2011-200731] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objectives Stratified management for low back pain according to patients' prognosis and matched care pathways has been shown to be an effective treatment approach in primary care. The aim of this within-trial study was to determine the economic implications of providing such an intervention, compared with non-stratified current best practice, within specific risk-defined subgroups (low-risk, medium-risk and high-risk). Methods Within a cost–utility framework, the base-case analysis estimated the incremental healthcare cost per additional quality-adjusted life year (QALY), using the EQ-5D to generate QALYs, for each risk-defined subgroup. Uncertainty was explored with cost–utility planes and acceptability curves. Sensitivity analyses were performed to consider alternative costing methodologies, including the assessment of societal loss relating to work absence and the incorporation of generic (ie, non-back pain) healthcare utilisation. Results The stratified management approach was a cost-effective treatment strategy compared with current best practice within each risk-defined subgroup, exhibiting dominance (greater benefit and lower costs) for medium-risk patients and acceptable incremental cost to utility ratios for low-risk and high-risk patients. The likelihood that stratified care provides a cost-effective use of resources exceeds 90% at willingness-to-pay thresholds of £4000 (≈ 4500; $6500) per additional QALY for the medium-risk and high-risk groups. Patients receiving stratified care also reported fewer back pain-related days off work in all three subgroups. Conclusions Compared with current best practice, stratified primary care management for low back pain provides a highly cost-effective use of resources across all risk-defined subgroups.
Collapse
Affiliation(s)
- David G T Whitehurst
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | | | | | | | | |
Collapse
|
49
|
Evaluation of a Randomized Controlled Trial in the Management of Chronic Lower Back Pain in a French Automotive Industry: An Observational Study. Arch Phys Med Rehabil 2011; 92:1927-1936.e4. [DOI: 10.1016/j.apmr.2011.06.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 12/31/2022]
|
50
|
Hill JC, Whitehurst DGT, Lewis M, Bryan S, Dunn KM, Foster NE, Konstantinou K, Main CJ, Mason E, Somerville S, Sowden G, Vohora K, Hay EM. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 2011; 378:1560-71. [PMID: 21963002 PMCID: PMC3208163 DOI: 10.1016/s0140-6736(11)60937-9] [Citation(s) in RCA: 909] [Impact Index Per Article: 69.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Back pain remains a challenge for primary care internationally. One model that has not been tested is stratification of the management according to the patient's prognosis (low, medium, or high risk). We compared the clinical effectiveness and cost-effectiveness of stratified primary care (intervention) with non-stratified current best practice (control). METHODS 1573 adults (aged ≥18 years) with back pain (with or without radiculopathy) consultations at ten general practices in England responded to invitations to attend an assessment clinic. Eligible participants were randomly assigned by use of computer-generated stratified blocks with a 2:1 ratio to intervention or control group. Primary outcome was the effect of treatment on the Roland Morris Disability Questionnaire (RMDQ) score at 12 months. In the economic evaluation, we focused on estimating incremental quality-adjusted life years (QALYs) and health-care costs related to back pain. Analysis was by intention to treat. This study is registered, number ISRCTN37113406. FINDINGS 851 patients were assigned to the intervention (n=568) and control groups (n=283). Overall, adjusted mean changes in RMDQ scores were significantly higher in the intervention group than in the control group at 4 months (4·7 [SD 5·9] vs 3·0 [5·9], between-group difference 1·81 [95% CI 1·06-2·57]) and at 12 months (4·3 [6·4] vs 3·3 [6·2], 1·06 [0·25-1·86]), equating to effect sizes of 0·32 (0·19-0·45) and 0·19 (0·04-0·33), respectively. At 12 months, stratified care was associated with a mean increase in generic health benefit (0·039 additional QALYs) and cost savings (£240·01 vs £274·40) compared with the control group. INTERPRETATION The results show that a stratified approach, by use of prognostic screening with matched pathways, will have important implications for the future management of back pain in primary care. FUNDING Arthritis Research UK.
Collapse
Affiliation(s)
- Jonathan C Hill
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Stoke-on-Trent, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|