Understanding cultural influences on back pain and back pain research

'I do hope more people can benefit from it.': The qualitative experience of individuals living with osteoarthritis who participated in the GLA:D™ program in Alberta, Canada

INTRODUCTION

The Good Life with osteoArthritis: Denmark (GLA:DTM) is an evidence-based program designed for individuals with symptomatic hip and knee osteoarthritis (OA). This program has reported improvement in pain, quality of life and self-efficacy, as well as delays in joint replacement surgery for adults with moderate to severe hip or knee OA. Evaluations of GLA:DTM implementation in several countries have focused on effectiveness, training, and feasibility of the program primarily from the provider perspective. Our objective was to examine how the GLA:DTM program was perceived and experienced by individuals with hip and knee OA to inform on-going program refinement and implementation.

METHODS

Thirty semi-structured telephone interviews were conducted with participants who completed the GLA:DTM program in Alberta. An interpretive description approach was used to frame the study and thematic analysis was used to code the data and identify emergent themes and sub-themes associated with participants' experience and perception of the GLA:DTM program.

RESULTS

Most participants had a positive experience of the GLA:DTM program and particularly enjoyed the group format, although some participants felt the group format prevented one-on-one support from providers. Three emergent themes related to acceptability were identified: accessible, adaptable, and supportive. Participants found the program to be accessible in terms of location, cost, and scheduling. They also felt the program was adaptable and allowed for individual attention and translatability into other settings. Finally, most participants found the group format to be motivating and fostered connections between participants.

CONCLUSION

The GLA:DTM program was perceived as acceptable by most participants, yet the group format may not be useful for all individuals living with OA. Recommended improvements included adapting screening to identify those suited for the group format, providing program access earlier in the disease progression trajectory, modifying educational content based on participants' knowledge of OA and finally, providing refresher sessions after program completion.

Predictors of response in PROMIS-global in a chronic low back pain specialty clinic: STarTBack and chronic overlapping pain conditions

BACKGROUND

Tools, such as the STarTBack Screening Tool (SBT), have been developed to identify risks of progressing to chronic disability in low back pain (LBP) patients in the primary care population. However, less is known about predictors of change in function after treatment in the specialty care population.

OBJECTIVE

We pursued a retrospective observational cohort study involving LBP patients seen in a multidisciplinary specialty clinic to assess which features can predict change in function at follow-up.

METHODS

The SBT was administered at initial visit, and a variety of patient characteristics were available in the chart including the presence of chronic overlapping pain conditions (COPCs). Patient Reported Outcomes Measurement Information System-10 (PROMIS-10) global physical health (PH) and global mental health (MH) were measured at baseline and at pragmatic time points during follow-up. Linear regression was used to estimate adjusted associations between available features and changes in PROMIS scores.

RESULTS

241 patients were followed for a mean of 17.0 ± 7.5 months. Mean baseline pain was 6.7 (SD 2.1), PROMIS-10 global MH score was 44.8 (SD 9.3), and PH score was 39.4 (SD 8.6). 29.7% were low-risk on the SBT, 41.8% were medium-risk, and 28.5% were high-risk. Mean change in MH and PH scores from baseline to the follow-up questionnaire were 0.86 (SD 8.11) and 2.39 (SD 7.52), respectively. Compared to low-risk patients, high-risk patients had a mean 4.35 points greater improvement in their MH score (p= 0.004) and a mean 3.54 points greater improvement in PH score (p= 0.006). Fewer COPCs also predicted greater improvement in MH and PH.

CONCLUSIONS

SBT and the presence of COPC, which can be assessed at initial presentation to a specialty clinic, can predict change in PROMIS following treatment. Effort is needed to identify other factors that can help predict change in function after treatment in the specialty care setting.

Efficacy of Core-Strengthening and Intensive Dynamic Back Exercises on Pain, Core Muscle Endurance, and Functional Disability in Patients with Chronic Non-Specific Low Back Pain: A Randomized Comparative Study

BACKGROUND

Chronic back pains are progressively disabling working individuals, including 60-80% of the general population, for which their diagnosis is challenging to healthcare workers worldwide, thereby becoming a burden to nations.

PURPOSE

The study aimed to investigate the efficacy of core strengthening exercise (CSE) and intensive dynamic back exercise (IDBE) on pain, core muscle endurance, and functional disability in patients with chronic non-specific low back pain (LBP).

METHODS

The study was based on a three-arm parallel-group randomized control design. Forty-five participants with chronic non-specific LBP were recruited and randomly divided into the CSE, IDBE, and Control groups. The CSE and IDBE groups received CSE and IDBE, respectively. However, the Control group received no intervention. Numeric pain rating scale, Oswestry Disability Index, core flexors, extensors, and side bridge tests assessed pain intensity, functional disability, and endurance of core muscles. Outcome scores for the dependent variables were collected at baseline (pre-intervention) and six-week post-intervention. There were no follow-up measurements in this study. A one-way multivariate analysis of covariance (MANCOVA) was used to analyze the intervention effects on the outcomes within groups and between groups, respectively; keeping the significance-level alpha at 95%, i.e., p < 0.05. A univariate F-test was performed to observe the superiority of one treatment over another. Pearson's correlation coefficient test was conducted to determine a relation between the dependent variables. In all statistical analyses, the level of significance α was kept at 0.05.

RESULTS

All forty-five out of sixty-three participants with chronic non-specific low back pain (male, 32 and female, 23; average age, 20.24 ± 1.46 years; average pain duration, 19.6 ± 5.42 weeks) completed the study and their data were analyzed. The MANCOVA test showed a significant difference between the treatment groups on the combined multiple endurance tests for the core muscles (flexors, extensors, side bridge tests to the right and left), Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores after controlling for baseline scores of all the dependent variables: F (6, 12) = 23.381; p < 0.05; Wilks' Λ = 0.033; partial η2 = 0.819. A post hoc pair-wise comparison followed by a univariate F-test indicated that a significant improvement was found between the CSE vs. IDBE vs. Control groups on the post-test scores of all the dependent variables except VAS and EET (CSE vs. IDBE only). A Pearson's correlation coefficient test revealed a notable relation between the dependent variables.

CONCLUSIONS

The experimental group CSE was found to be more effective than IDBE on improving functional disability, cores' flexors, and side bridges' endurance tests than IDBE. The magnitude of this improvement exceeded the minimal clinically important difference (MCID), suggesting a clinically relevant enhancement in functional disability, core flexors, and side bridge endurance for participants engaged in CSE. However, CSE vs. IDBE revealed non-significant differences on reducing pain and core extensors' endurance. The absence of statistically significant differences suggests that the observed changes did not exceed the established MCID for pain intensity and core extensors' endurance. In addition, partial eta-squared value revealed the superiority of CSE over IDBE and Control groups. This suggests that the observed differences between the two interventions are not only statistically significant, but also clinically relevant, surpassing the established MCID.

Improving Rehabilitation Research to Optimize Care and Outcomes for People with Chronic Primary Low Back Pain: Methodological and Reporting Recommendations from a WHO Systematic Review Series

Chronic primary low back pain (CPLBP) is a prevalent and disabling condition that often requires rehabilitation interventions to improve function and alleviate pain. This paper aims to advance future research, including systematic reviews and randomized controlled trials (RCTs), on CPLBP management. We provide methodological and reporting recommendations derived from our conducted systematic reviews, offering practical guidance for conducting robust research on the effectiveness of rehabilitation interventions for CPLBP. Our systematic reviews contributed to the development of a WHO clinical guideline for CPLBP. Based on our experience, we have identified methodological issues and recommendations, which are compiled in a comprehensive table and discussed systematically within established frameworks for reporting and critically appraising RCTs. In conclusion, embracing the complexity of CPLBP involves recognizing its multifactorial nature and diverse contexts and planning for varying treatment responses. By embracing this complexity and emphasizing methodological rigor, research in the field can be improved, potentially leading to better care and outcomes for individuals with CPLBP.

Effect of Video-Assisted Isometric Strengthening Exercise Program on Pain and Muscle Strength Poststabilization of Lower Limb Fracture

The benefits of isometric strengthening exercises (ISEs) are compromised when patient teaching on ISEs is delayed and/or ineffectively delivered due to healthcare resources constraint, especially when health resources are stretched, as occurred during the COVID-19 pandemic. This study aims to examine the effect of a video-assisted ISE program on pain and muscle strength of patients following surgical stabilization of lower limb fracture. A quasi-experimental study with repeated measures was employed. Primary study outcomes were assessed using the Brief Pain Inventory and Manual Muscle Test. Effects over time were analyzed using generalized estimating equations. In comparison with usual care group (n = 32), the intervention group (n = 33) showed better pain reduction over time (p < .001, effect size [ES] = 0.39-1.77) and muscle strength preservation (p < .05; ES = 0.8-0.9). Patient acceptance of the intervention was favorable. Integration of video clips into patient teaching on ISEs is potentially beneficial in managing pain and muscle strength; it can be easily deployed to aid early ISE initiation.

Toward a causal model of chronic back pain: Challenges and opportunities

Chronic low back pain (cLBP) afflicts 8. 2% of adults in the United States, and is the leading global cause of disability. Neuropsychiatric co-morbidities including anxiety, depression, and substance abuse- are common in cLBP patients. In particular, cLBP is a risk factor for opioid addiction, as more than 50% of opioid prescriptions in the United States are for cLBP. Misuse of these prescriptions is a common precursor to addiction. While associations between cLBP and neuropsychiatric disorders are well established, causal relationships for the most part are unknown. Developing effective treatments for cLBP, and associated co-morbidities, requires identifying and understanding causal relationships. Rigorous methods for causal inference, a process for quantifying causal effects from observational data, have been developed over the past 30 years. In this review we first discuss the conceptual model of cLBP that current treatments are based on, and how gaps in causal knowledge contribute to poor clinical outcomes. We then present cLBP as a "Big Data" problem and identify how advanced analytic techniques may close knowledge gaps and improve clinical outcomes. We will focus on causal discovery, which is a data-driven method that uses artificial intelligence (AI) and high dimensional datasets to identify causal structures, discussing both constraint-based (PC and Fast Causal Inference) and score-based (Fast Greedy Equivalent Search) algorithms.

Almost one in five physiotherapy trials excluded people due to lack of language proficiency: A meta-epidemiological study

OBJECTIVES

The objective of the study was to examine the characteristics of randomized controlled trials (RCTs) evaluating physiotherapy interventions for low back pain (LBP) that specified a language-grounded eligibility criterion and the proportion of people being excluded consequently.

STUDY DESIGN AND SETTING

This is a meta-epidemiological study of RCTs evaluating at least one type of physiotherapy intervention for treatment or prevention of LBP. Records were retrieved from Physiotherapy Evidence Database (PEDro), LILACS, and SciELO from inception to May 2021. We retrieved metadata of each record from PEDro and extracted from included studies: country of recruitment, language-grounded eligibility criterion, and the number of consequent exclusions (if specified).

RESULTS

This study included 2,555 trials. A language-grounded eligibility criterion was specified in 463 trials (18.1%); the proportion was higher in trials conducted in North America and Europe, published after 2000, investigating cognitive and behavioral interventions, and including large sample size. Of these 463 trials, 75 trials (16.2%) reported a total number of 2,152 people being excluded due to lack of language proficiency, equivalent to 12.5% of randomized participants.

CONCLUSION

Nearly one in five physiotherapy clinical trials on LBP excludes people based on language proficiency, compromising the evidence to manage LBP in minority populations.

Fear-Avoidance Beliefs, Kinesiophobia, and Disability Risk Among Indians with Spine Pain

PURPOSE

To determine the burden of fear-avoidance beliefs (FAB), kinesiophobia, and risk of persistent disability among Indians with spine pain.

METHODS

Demographic and clinical data collected from 139 patients who attended a spine rehabilitation clinic for assessment and treatment of their spine pain were analyzed. Fear-avoidance beliefs, kinesiophobia, and risk of persistent disability were measured using the Fear-avoidance Beliefs Questionnaire (FABQ), Tampa Scale for Kinesiophobia (TSK), and the STarT Back Tool (SBT). A multivariate analysis was performed to determine the effect of pain, disability, age, gender, BMI, lifestyle, pain duration, and pain location on FAB, TSK, and SBT scores.

RESULTS

A majority of patients had medium to high-risk FAB-physical activities (FAB-P) (50.5%) and SBT (54%) scores. The percentage of patients with medium or high-risk FAB-P (p = 0.03), FAB-work (FAB-W) (p = 0.03), and SBT (p = 0.03) scores were significantly higher in patients with pain score > 7, and the percentage of patients with medium or high-risk with FAB-P (p < 0.0001), TSK (p = 0.0003), and SBT (p < 0.0001) scores were significantly higher in patients with severe, crippled or bed-ridden disability. Disability was the only significant predictor for FAB-W, FAB-P, and SBT scores.

CONCLUSION

The prevalence of fear-avoidance beliefs and risk of persistent disability was significant among Indians and should be taken into account while planning treatment for their spine pain.

Physical therapists' perceptions of and satisfaction with delivering telerehabilitation sessions to patients with knee osteoarthritis during the Covid-19 pandemic: Preliminary study

OBJECTIVE

This preliminary study was conducted to explore physical therapists' (PT) perceptions of and satisfaction with delivering telerehabilitation sessions to patients with knee osteoarthritis during the Covid-19 pandemic.

STUDY DESIGN

An exploratory preliminary study using an internet-based survey followed by focus group sessions.

METHODS

A programme of sessions was administered by 12 PTs from the Physical Therapy Department at Prince Sultan Military Medical City. An internet-based survey containing 17 statements was completed by the PTs.

RESULTS

With regard to telephone-delivered care, four statements related to patients' privacy, programme convenience, safe patients time and money achieved consensus agreement (≥75% agreed or strongly agreed), there was majority agreement (≥50% of respondents agreed or strongly agreed) with seven of the statements regarding the effectiveness, affordability and safety of the programme, but there was no consensus with regard to the remaining five statements. In addition, most of the participants (84.6%) believed that a telephone consultation should cost 25% or 50% less than a face-to-face session.

CONCLUSION

Despite the lack of physical contact with patients, the PTs agreed that telerehabilitation would offer patients an easy method of being prescribed a therapeutic programme, save time and money, and maintain patient privacy. Further, the PTs reported barriers and suggested adaptations for this method of service delivery.

System for Game-like Therapy in Balance Issues Using Audiovisual Feedback and Force Platform

Background: The aim of the work is to verify the usability of a stabilometric platform and audiovisual feedback in the group-based therapy of patients with vertebral algic syndrome, to analyze an immediate effect after a single therapeutic unit, and to analyze differences between male and female probands. Methods: The study included 189 patients (90 male, age 55 ± 12 and 89 female, age 52 ± 12). All patients received group balance therapy with a portable medical device, Homebalance MA. The intervention consisted of measurement of quiet stance and a reference training scene before and after 15 min of game-like balance training with audiovisual feedback. Results: A statistically significantly lower value of the body sway trajectory during quiet stance was detected in men than in women. After a single therapy session, there was a statistically significant improvement in quiet stance with visual feedback, and marginal statistically significant improvement in the time required to complete the reference training scene. Conclusions: Homebalance MA is a utilizable tool for group therapy. The use of group game-like balance training increases the availability of physiotherapeutic intervention for a larger number of patients, while maintaining the positive effect of the therapy.

Cross-cultural adaptation, reliability and validity of the Marathi versions of the Back Beliefs Questionnaire and Pain Self-Efficacy Questionnaire in people living with chronic low back pain

PURPOSE

To translate and cross-culturally adapt the Back Beliefs Questionnaire (BBQ) and Pain Self-Efficacy Questionnaire (PSEQ) into Marathi, and to evaluate their clinimetric properties in a native Marathi speaking population with chronic low back pain.

MATERIAL AND METHODS

The BBQ and PSEQ were translated into Marathi using international published guidelines. Fifty native Marathi speakers were recruited. Reliability (n = 43) was evaluated in terms of internal consistency (Cronbach α) and test-retest reliability [intra class correlation coefficient, ICC (2, 1)] and 95% confidence interval (CI). Convergent validity (n = 50) was assessed by correlating the Marathi versions of BBQ and PSEQ with the Marathi version of Roland Morris Disability Questionnaire (RMDQ).

RESULTS

Internal consistency of BBQ (Cronbach α  =  0.67) was good and that for PSEQ (Cronbach α  =  0.93) was high. Test-retest reliability for BBQ (ICC =  0.80; 95% CI: 0.66 to 0.89) was good and PSEQ (ICC = 0.85; 95% CI: 0.74 to 0.92) was excellent. A significant, low negative correlation was found between RMDQ and BBQ scores (r = -0.298; p = 0.036) and PSEQ (r = -0.28; p = 0.049).

CONCLUSIONS

The BBQ and PSEQ were successfully cross-culturally adapted into Marathi. Clinimetric evaluation of these questionnaires in a sample of native Marathi speaking populations with chronic low back pain demonstrated good acceptability, acceptable internal consistency, and high test-retest reliability.Implications for rehabilitationThe Back Beliefs Questionnaire (BBQ) and Pain Self Efficacy Questionnaire (PSEQ) were successfully cross-culturally adapted into Marathi.The Marathi versions of BBQ and PSEQ have good acceptability, acceptable internal consistency, and high test-retest reliability.They can be used by clinicians and researchers to evaluate beliefs about back pain and pain self-efficacy in Marathi speaking patients with chronic low back pain.

Magnitude and associated factors of low back pain among nurses working at intensive care unit of public hospitals in Amhara region, Ethiopia

Background

Low back pain is a common public health problem throughout the world with a global prevalence from 28% to 86%. Nurses working in intensive care units are handling people who are critically ill and helpless, which requires more assistance for transferring and handling activities. This possesses a risk for low back pain but little is known about it in Ethiopia. This study aimed to assess the magnitude of low back pain and associated factors among nurses who work at intensive care units in Amhara region public hospitals, North Ethiopia.

Methods

A multi-centered institution-based cross-sectional study was conducted at Amhara region public hospitals from March 1-30, 2020. A simple random sampling technique after proportional allocation was used to select the study participants. Data were collected using a standard modified Nordic musculoskeletal assessment tool. After data were checked for completeness and consistency, it was entered into Epidata version 3.1 and exported to Statistical Package for Social Science software version 26 for analysis. Descriptive statistics were computed. A binary logistic regression model was used to identify factors associated with low back pain. Finally, those variables with a p-value of <0.05 in multivariable analysis were considered statistically significant.

Result

Study was conducted among 412 intensive care unit nurses giving a response rate of 97.6%. The magnitude of low back pain was 313 (76%) [95% CI: (71.6%-79.9%)]. Being female [AOR = 2.674 (1.404, 5.076)], unavailability of assistive device for patient handling [AOR = 2.139 (1.035, 4.410)], lack of training on intensive care [AOR = 2.017 (1.092, 3.943)], lack of regular exercise [AOR = 2.164 (1.164, 4.108)] and job stress [AOR = 3.66 (1.955, 6.498)] were factors significantly associated with low back pain.

Conclusions

In this study the magnitude of low back pain was high. Being female, unavailability of an assistive device for patient handling, lack of training on intensive care, lack of regular exercise and job stress were factors associated with low back pain. Policymakers and concerned bodies should emphasize the accessibility of assistive devices for patient care, provision of training on intensive care, and adaptive working environment for intensive care unit nurses.

Low back pain prevalence, beliefs and treatment-seeking behaviour in multi-ethnic Suriname

Objectives

The aims were to determine, for the first time, the prevalence of low back pain (LBP) in urban and rural communities and to assess back beliefs and treatment-seeking behaviour in Suriname, a multi-ethnic country in the Caribbean community.

Methods

A cross-sectional community-based survey using the Community Oriented Program for the Control of Rheumatic Diseases methodology was performed between April 2016 and July 2017. Information was collected on LBP prevalence and LBP-related treatment seeking, beliefs about LBP [Back Beliefs Questionnaire (BBQ)], level of disability (Oswestry Disability Index) and the risk of developing persistent disabling pain (Start Back Screening Tool).

Results

A total of 541 out of 2902 individuals reported current acute or chronic LBP. It was more prevalent in urban (20.2%) than in rural (13.7%) communities, especially in females and older adults (>55 years of age). Individuals from rural areas [median BBQ = 18.00 (14.00-22.00)] had significantly more negative beliefs than the urban population [median BBQ = 25.00 (19.00-31.00); P < 0.001]. Maroons displayed more negative beliefs than Creole (P = 0.040), Hindustani (P < 0.001), Javanese (P < 0.001) and mixed ethnicity (P < 0.001) groups. At least 75% of the LBP population sought care, especially from a western health-care practitioner. Seeking treatment and having a higher risk of developing persistent disabling pain was significantly associated with more disability (P < 0.001). Age ≥45 years (P < 0.001), Indigenous ethnicity (P < 0.05) and functional disability (P < 0.001) were factors influencing treatment seeking.

Conclusion

Low back pain is a prevalent health problem in the Surinamese urban community, especially in older adults and among females. Most individuals experiencing LBP visited a western health-care practitioner and had more negative beliefs compared with other communities.

Applying the NIA Health Disparities Research Framework to Identify Needs and Opportunities in Chronic Musculoskeletal Pain Research

Disparities in the experience of chronic musculoskeletal pain in the United States stem from a confluence of a broad array of factors. Organized within the National Institute on Aging Health Disparity Research Framework, a literature review was completed to evaluate what is known and what is needed to move chronic musculoskeletal pain research forward specific to disproportionately affected populations. Peer-reviewed studies published in English, on human adults, from 2000 to 2019, and conducted in the United States were extracted from PubMed and Web of Science. Articles were reviewed for key words that focused on underrepresented ethnic/race groups with chronic musculoskeletal pain applying health factor terms identified in the NIAHealth Disparity Research Framework four levels of analysis: 1) environmental, 2) sociocultural, 3) behavioral, and 4) biological. A total of 52 articles met inclusion criteria. There were limited publications specific to underrepresented ethnic/race groups with chronic musculoskeletal pain across all levels with particular research gaps under sociocultural and biological categories. Current limitations in evidence may be supplemented by a foundation of findings specific to the broader topic of "chronic pain" which provides guidance for future investigations. Study designs including a focus on protective factors and multiple levels of analyses would be particularly meritorious. PERSPECTIVE: Chronic musculoskeletal pain unequally burdens underrepresented ethnic/race groups. In order to move research forward and to systematically investigate the complex array of factors contributing toward health disparities, an organized approach is necessary. Applying the NIA Health Disparities Research Framework, an overview of the current state of evidence specific to chronic musculoskeletal pain and underrepresented ethnic/race groups is provided with future directions identified.

Analgesic Efficacy of Intraoperative Nerve Blocks for Primary Palatoplasty

BACKGROUND

Cleft palate is a common craniofacial malformation, requiring surgical repair in late infancy or early toddlerhood. Postoperative use of opioids is common to mitigate pain following palatoplasty. To decrease opioid consumption, improve postoperative pain, and decrease complications associated with general anesthetics, intraoperative regional nerve blocks have been employed for multimodal pain relief. While the literature supports intraoperative nerve block use for postprocedural comfort in children undergoing palatoplasty, the topic has not been systematically summarized.

OBJECTIVES

The purpose of this review was to explore the efficacy of nerve block in palatoplasty, in addition to analyzing trends in nerve block modality and choice of local anesthetic on postoperative pain and opioid consumption.

METHODS

A systematic literature search was conducted through PubMed, Embase, Cochrane, and Web of Science databases for studies on cleft palate nerve block. Resulting reference lists were searched for potential eligible studies and then reviewed, with an emphasis on pain scores, postoperative analgesia consumption, and time to analgesia use.

RESULTS

A total of 259 articles were reviewed, of which 10 met inclusion criteria. Intraoperative suprazygomatic and greater palatine nerve blocks were the 2 most commonly reported blocks. Long acting agents, such as bupivacaine and ropivacaine, were the local anesthetic of choice. All modalities were effective in reducing postoperative pain scores and opioid consumption.

CONCLUSION

Intraoperative nerve blocks have been shown to be incredibly effective in reducing postoperative pain in children undergoing palatoplasty, minimizing both opioid consumption and recovery time. The existing literature suggests that suprazygomatic block with combined bupivacaine and dexmedetomidine is the preferred nerve block modality. Ultrasound guidance should be used when accessible.Level of Evidence: 2.

Group Differences Between Countries and Between Languages in Pain-Related Beliefs, Coping, and Catastrophizing in Chronic Pain: A Systematic Review

Objective

To evaluate the extent to which pain-related beliefs, appraisals, coping, and catastrophizing differ between countries, language groups, and country economy.

Design

Systematic review.

Methods

Two independent reviewers searched 15 databases without restriction for date or language of publication. Studies comparing pain beliefs/appraisals, coping, or catastrophizing across two or more countries or language groups in adults with chronic pain (pain for longer than three months) were included. Two independent reviewers extracted data and performed the quality appraisal. Study quality was rated as low, moderate, or high using a 10-item modified STROBE checklist. Effect sizes were reported as small (0.20–0.49), medium (0.50–0.79), or large (≥0.80).

Results

We retrieved 1,365 articles, read 42 potential full texts, and included 10 (four moderate-quality, six low-quality) studies. A total of 6,797 adults with chronic pain (33% with chronic low back pain) were included from 16 countries. Meta-analysis was not performed because of heterogeneity in the studies. A total of 103 effect sizes were computed for individual studies, some of which indicated between-country differences in pain beliefs, coping, and catastrophizing. Of these, the majority of effect sizes for pain beliefs/appraisal (60%; eight large, eight medium, and eight small), for coping (60%; seven large, 11 medium, and 16 small), and for catastrophizing (50%; two medium, one small) evidenced statistically significant between-country differences, although study quality was low to moderate.

Conclusions

In 50% or more of the studies, mean scores in the measures of pain beliefs and appraisals, coping responses, and catastrophizing were significantly different between people from different countries.

Patient experiences with physiotherapy for knee osteoarthritis in Australia-a qualitative study

OBJECTIVE

Physiotherapists commonly provide non-surgical care for people with knee osteoarthritis (OA). It is unknown if patients are receiving high-quality physiotherapy care for their knee OA. This study aimed to explore the experiences of people who had recently received physiotherapy care for their knee OA in Australia and how these experiences aligned with the national Clinical Care Standard for knee OA.

DESIGN

Qualitative study using semistructured individual telephone interviews and thematic analysis, where themes/subthemes were inductively derived. Questions were informed by seven quality statements of the OA of the Knee Clinical Care Standard. Interview data were also deductively analysed according to the Standard.

SETTING

Participants were recruited from around Australia via Facebook and our research volunteer database.

PARTICIPANTS

Interviews were conducted with 24 people with recent experience receiving physiotherapy care for their knee OA. They were required to be aged 45 years or above, had activity-related knee pain and any knee-related morning stiffness lasted no longer than 30 min. Participants were excluded if they had self-reported inflammatory arthritis and/or had undergone knee replacement surgery for the affected knee.

RESULTS

Six themes emerged: (1) presented with a pre-existing OA diagnosis (prior OA care from other health professionals; perception of adequate OA knowledge); (2) wide variation in access and provision of physiotherapy care (referral pathways; funding models; individual vs group sessions); (3) seeking physiotherapy care for pain and functional limitations (knee symptoms; functional problems); (4) physiotherapy management focused on function and exercise (assessment of function; various types of exercises prescribed; surgery, medications and injections are for doctors; adjunctive treatments); (5) professional and personalised care (trust and/or confidence; personalised care) and (6) physiotherapy to postpone or prepare for surgery.

CONCLUSION

Patients' experiences with receiving physiotherapy care for their knee OA were partly aligned with the standard, particularly regarding comprehensive assessment, self-management, and exercise.

Low Back Pain-Related Disability Is Associated with Pain-Related Beliefs Across Divergent Non-English-Speaking Populations: Systematic Review and Meta-Analysis

OBJECTIVES

This systematic review and meta-analysis examined relationships between low back pain (LBP)-related disability and pain beliefs, including pain catastrophizing, pain-related fear, self-efficacy, and back pain beliefs, in non-English-speaking populations. Additionally, the effects of selected cultural factors (i.e., language/geographic area) on the strength of relationships were examined.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

Nine databases were searched. Studies included observational or randomized control clinical trials. Eligible studies had to report estimates of the association between pain beliefs and disability. Pooled estimates of correlation coefficients were obtained through random-effects meta-analysis methods.

RESULTS

Fifty-nine studies, (n = 15,383) were included. Moderate correlations were identified between disability and pain self-efficacy (chronic LBP r = -0.51, P ≤ 0.001), between disability and pain catastrophizing (acute LBP r = 0.47, P ≤ 0.001; chronic LBP r = 0.44, P ≤ 0.001), and also between disability and pain-related fear (chronic LBP r = 0.41, P ≤ 0.001). Otherwise, weak correlations were identified between disability and most pain beliefs (range r = -0.23 to 0.35, P ≤ 0.001). Pooled correlation coefficients between disability and all pain beliefs (except the Fear Avoidance Belief Questionnaire-Work subscale) represent medium effects and suggest that lower disability was associated with greater pain self-efficacy, less pain-related fear, less catastrophic thinking, and less negative back pain beliefs about the nature and cause of back pain. Results were consistent across most language groups and geographic regions; few studies reported ethnicity or religion.

DISCUSSION

LBP-related disability was associated with pain-related beliefs, with consistency demonstrated for each pain belief construct across divergent non-English-speaking populations. Further research examining cultural factors, such as ethnicity or religion, and with a more diverse population is warranted.

Low back pain and sexual disability from the patient's perspective: a qualitative study

PURPOSE

The aim of this qualitative study is to investigate, from patient's perspective, the aspects of the relationship between low back pain and sexual life on physical, psychological and social aspects of individual's life. In addition, this study aims to explore patients' opinions on the role of health care providers in addressing and treating low back pain-related sexual problems.

MATERIALS AND METHODS

Semi-structured interviews were conducted with 26 outpatients referred to physical therapy for subacute or chronic non-specific low back pain; the questions investigated the presence of sexual disability and aspects related to patient's behaviour. Two independent physical therapists, supervised by a third expert physical therapist and a clinical psychologist proficient in qualitative methodology, performed thematic content analysis to identify categories and themes.

RESULTS

Patients with low back pain consider sexual disability severely limiting and correlated to pain. This study emphasized the perception of invalidity, the importance of the relationship with the partner, the emotions and gender roles in the couple, and the relevance for health care providers to take part in the clinical management. The physical therapist is believed to be a qualified figure to address this issue and specific suggestions on sexual activity could be useful.

CONCLUSION

Sexual disability in patients with subacute or chronic LBP acquires an important and individual meaning that can be investigated within the therapeutic context, especially by physical therapists.Implications for RehabilitationSexual disability related to low back pain is considered an important and meaningful topic from the patient's perspective.This reflects the importance of the emotional relationship with the partner.Within the therapeutic context, it is important to provide information to help manage pain during sexual activity.The physical therapist is seen to be a qualified figure to address this issue.

How do people in China think about causes of their back pain? A predominantly qualitative cross-sectional survey

Background

Low back pain (LBP) is the second highest cause of health burden in China. Delayed recovery, poor clinical outcomes and persistence of LBP are associated with negative pain beliefs about LBP. Chinese philosophies are nested into the daily life of people in China, which is likely to influence pain beliefs. However, there is lack of knowledge about people’s discourses regarding their LBP in China. The primary aim of this study was to explore the discourses underlying the beliefs of people in China about what causes their persistent or recurrent LBP. The secondary aim was to investigate the sources of these pain beliefs.

Methods

People (n = 152) from South Central, East and North Mainland China with LBP completed an online survey about what they believed caused their persistent or recurrent LBP and where these understandings came from. Potential causes of persistent or recurrent LBP were explored qualitatively using discourse analysis. The sources of these discourses were assessed by descriptive statistics with conventional content analysis.

Results

Five discourses were identified to underpin participants’ beliefs about what caused their persistent or recurrent LBP, namely: (1) biomedical problems (66.4%), (2) unbalanced lifestyle (48.7%), (3) menstruation and ‘kidney’ status (9.2%), (4) the ‘Five Elements’ imbalance (7.9%), and (5) energy status (5.9%). Most participants responded that their pain beliefs were based on information derived from healthcare professionals (59.2%), followed by the internet (24.3%) and family (23.0%).

Conclusions

People from moderately and well-developed parts of Mainland China think predominantly in line with a Western biomedical viewpoint about their LBP. Traditional Chinese medicine related pain beliefs mainly to the concept of ‘balance’ were evident on contemporary Chinese society’s understandings of LBP. These cultural beliefs could be relevant to consider in LBP management and involve healthcare professionals, family and patient in this process.

Profile of Patients With Acute Low Back Pain Who Sought Emergency Departments: A Cross-sectional Study

STUDY DESIGN

A cross-sectional study.

OBJECTIVE

The aim of this study is to describe the profile of patients with acute low back pain (LBP) who sought emergency departments (EDs) in Brazilian public hospitals. We also described the profile of these patients according to the STarT Back Screening Tool (SBST).

SUMMARY OF BACKGROUND DATA

LBP is the most common musculoskeletal condition worldwide and is one of the main complaints in EDs. There is a lack of evidence describing the profile of these patients from low- to middle-income countries.

METHODS

This is a cross-sectional study involving patients with a new episode of nonspecific acute LBP that was conducted between August 2014 and August 2016. Variables related to clinical, psychological, sociodemographic and work status characteristics were investigated through structured, in-person oral questionnaire.

RESULTS

A total of 600 patients were included in the study. The majority of the patients were women (58%), with a median of eight points on pain intensity (measured on an 11-point scale) and 17 points on disability (measured on a 24-item questionnaire). With regards to the SBST evaluation, 295 (49.2%) patients were classified as being at high risk of developing an unfavorable prognosis with a median pain intensity of nine points on pain intensity, 20 points on disability, and seven points on depression (measured on an 11-point scale). Despite this, the majority of the patients (74%) continued working normally without interference from LBP.

CONCLUSION

Identifying the profile of patients seeking care in EDs can help to define effective management for LBP in low- and middle-income countries. Patients with nonspecific acute LBP who seek EDs in Brazil present high levels of pain intensity and disability. Most patients were classified as having a high risk of developing an unfavorable prognosis.

LEVEL OF EVIDENCE

2.

Do pain management websites foster self-management support for people with persistent pain? A scoping review

OBJECTIVES

To evaluate if the contents of pain management websites include the current best practice self-management support strategies for people with persistent pain, are cultural tailored and to determine the website quality.

METHODS

Websites were searched from three major search engines (Google, Bing, and Yahoo). Websites providing information on self-management strategies and websites that were freely available to the public were included. The website contents were evaluated using a 14-item self-management support (SMS-14) checklist. Website quality was assessed using the Health On the Net code (HONcode) certification.

RESULTS

Of the twenty-seven websites evaluated, the websites scored a median of nine items (range 1-13) from the SMS-14 checklist. The websites LivePlanBe, ACI Pain Management Network and MyJointPain top-scored (13/14) from the SMS-14 checklist. One website (ACI Pain Management Network) provided culturally tailored information and HONcode certification was present in six websites.

CONCLUSIONS

The review identified 27 contemporary pain management websites that could be used for self-management skills training.

PRACTICE IMPLICATIONS

Clinicians could refer people with persistent pain to top ranked websites - LivePlanBe, ACI Pain Management Network, and MyJointPain for enabling self-management skills, with the caveats that most websites lacked cultural tailoring, and have limited or no evidence of clinical efficacy.

Multidimensional prognostic factors for chronic low back pain-related disability: a longitudinal study in a Saudi population

BACKGROUND CONTEXT

Chronic low back pain (CLBP) is a major health problem. Identifying prognostic factors is essential for identifying people at risk of developing CLBP-related disability.

PURPOSE

To examine associations between CLBP-related disability at 12-month follow-up and individual, psychosocial and physical factors at baseline, as well as treatment-related factors between baseline and 12-month follow-up among a Saudi population. Additionally, associations between pain intensity and general perceived efficacy (GPE) at 12 months were examined with the aforementioned factors.

DESIGN

A prospective cohort study.

PARTICIPANTS

One hundred Saudi participants over 18 years with a history of LBP greater than 3 months' duration.

MAIN OUTCOME MEASUREMENTS

The primary outcome variable was CLBP-related disability measured by the Arabic Oswestry disability index. Secondary outcome measures were pain intensity over the prior week measured by the VAS and the participant's global perceptions of recovery (general perceived efficacy [GPE]) at 12 months.

METHODS

At baseline (n=115), participants completed questionnaires covering demographics, disability, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. They performed standardized physical performance tests, including assessment of pain behaviors using a pain behavior scale. After 12 months, participants (n=100) completed questionnaires on disability, pain intensity, GPE and provided treatment-related information during the previous year. Predictors of disability, pain, and GPE were explored using univariate and multivariate regression analyses.

RESULTS

The prognostic model for moderate-severe CLBP-related disability at 12 months explained 53.0% of the variance. Higher pain intensity, higher fear-avoidance work, and older age predicted higher disability. Having no additional somatic symptoms predicted lower disability. Pain intensity at 12-month follow-up was explained by higher disability at baseline, while not being in paid employment appeared protective (25.7% of variance explained). As univariate associations were weak between predictor variables and GPE, multivariate analysis was not conducted.

CONCLUSION

The study results supported the multifactorial nature of CLBP and reported an important prognostic model in the Saudi population.

Recognising ethnocultural diversity in chronic pain assessment: validation of the Pictorial Representation of Illness and Self Measure (PRISM) for use with culturally diverse communities

BACKGROUND

A comprehensive and accurate assessment of pain is critical for successful pain management. However, there is a lack of reliable and valid assessment tools for exploring multidimensional aspects of the chronic pain experience in culturally and linguistically diverse communities. This study investigates the reliability and validity of the Pictorial Representation of Illness and Self Measure + (PRISM+) for evaluating pain-related suffering and the sociocultural context of chronic pain within culturally and linguistically diverse patient cohorts.

METHOD

Three prospective validation studies are reported for three culturally and linguistically diverse communities. Two hundred and fifty-one patients with chronic pain who self-identified as Assyrian (n = 85), Arabic (n = 83) or Vietnamese (n = 83) completed a PRISM+ assessment, alongside a battery of standardised pain assessments. To evaluate construct validity, the position of the 'pain' disk placement was correlated with the Brief Pain Inventory (BPI), Depression Anxiety and Stress Scale (DASS), and the Short-Form 36 Health Survey (SF-36). For content validity, thematic analysis of patient narratives accompanying each disk placement was conducted. Test-retest reliability of repeated 'pain' and five additional disks (PRISM+) values was analysed using intra-class correlation coefficients.

RESULTS

The PRISM pain assessment demonstrated moderate to good test-retest reliability for Arabic (ICC 0.76; 95% CI 0.65-0.84), Assyrian (ICC 0.65; 95% CI 0.50-0.76) and Vietnamese (ICC 0.82; 95% CI 0.73-0.88) patients. Moderate correlations between the PRISM 'pain' disk and sub-scores for the BPI, DASS and SF-36 were found (p < 0.001). Patient interpretations of the 'pain' disk aligned with accepted definitions of suffering, supporting content validity for PRISM. For the additional disks (PRISM+), moderate to good test-retest reliability (ICC 0.67-0.88) was observed and qualitative analysis highlighted each disk reflected social and cultural values.

CONCLUSION

The PRISM demonstrates acceptable psychometric properties for measuring pain-related suffering for participants with chronic pain across three culturally and linguistically diverse communities. The use of additional disks (PRISM+) presents a reliable and valid option for exploring social and cultural dimensions of chronic pain in clinical encounters.

Development of pain in older adults: a latent class analysis of biopsychosocial risk factors

Pain significantly restricts the quality of life and well-being of older adults. With our increasingly ageing population, it is important to examine whether differing classes of biopsychosocial risk factors can predict the development of pain in older adults. Latent class analysis provides a model-based approach to identifying underlying subgroups in a population, based on some measured characteristics. In this study, latent class analysis was used to identify biopsychosocial risk classes in people aged 50 years and older, from The Irish Longitudinal Study on Ageing, who reported not often being troubled by pain at wave 1 and completed the 2-year follow-up at wave 2 (n = 4458). Four classes were identified based on 11 potential risk factors at wave 1. These classes were characterised as "Low Risk," "Physical Health Risk," "Mental Health Risk," and "High Risk." The Low-Risk class accounted for over half the sample (51.2%), whereas the High-Risk class represented 7.8% of the sample. At follow-up (wave 2), 797 (17.9%) participants reported being troubled by pain. Associations between the biopsychosocial risk classes and developing pain were examined using logistic regression, adjusting for sociodemographic variables. The High-Risk class was more likely to develop pain compared with the Low-Risk class (adjusted OR = 3.16, 95% CI = 2.40-4.16). These results add to existing data in other populations supporting the role of a range of biopsychosocial risk factors that increase the risk of developing pain. These findings have important implications for the identification, and potential moderation, of these risk factors.

Psychological and work-related outcomes after inpatient multidisciplinary rehabilitation of chronic low back pain: a prospective randomized controlled trial

Background

This study investigated the long-term effects (12 months post-rehabilitation) of a standard inpatient multidisciplinary rehabilitation program for patients with chronic low back pain (CLBP), in which a control group (CG) received pain competence training and an intervention group (IG) received combined pain competence and depression prevention training.

Methods

In this prospective control group study with cluster-block randomization, a total of n = 583 patients were included into per protocol analyses. To examine the effects of rehabilitation on depressive symptoms, pain self-efficacy, and work ability, patients were stratified in repeated-measures analyses of variance by treatment condition (IG vs. CG), level of depressive symptoms (low vs. high), and time of assessment (pre, post, 6, and 12 months after rehabilitation). The impact of each treatment on pain-related days of sick leave (DSL; dichotomized into ≤ vs. > 2 weeks) was determined separately by conducting non-parametric analyses. Multiple imputations (n = 1225) confirmed the results. Effects were interpreted if clinical significance was given.

Results

Only patients with high levels of depressive symptoms showed long-term improvements in depressive symptoms and self-efficacy. Long-term improvements in work ability index and mental work ability item were restricted to the IG. Furthermore, long-term effects on pain-related DSL were ascertained by per protocol and multiple imputation analyses only for the IG.

Conclusions

Patients with high levels of depressive symptoms showed improvements in depressive symptoms and self-efficacy, supporting the psychological effectiveness of both interventions. However, the beneficial long-term effects of rehabilitation on work ability and pain-related DSL among the IG support implementation of combined pain competence and depression prevention training.

Trial registration

DRKS00015465 (German Clinical Trial Register DRKS); date of registration: 03.09.2018.

Electronic supplementary material

The online version of this article (10.1186/s40359-019-0282-3) contains supplementary material, which is available to authorized users.

Evaluation of Self-Management Support Functions in Apps for People With Persistent Pain: Systematic Review

Background

Smartphone apps are a potential mechanism for development of self-management skills in people with persistent pain. However, the inclusion of best-practice content items in available pain management apps fostering core self-management skills for self-management support is not known.

Objective

The aim of the study was to evaluate the contents of smartphone apps providing information on pain management strategies for people with persistent pain facilitating self-management support and to appraise the app quality.

Methods

A systematic search was performed in the New Zealand App Store and Google Play Store. Apps were included if they were designed for people with persistent pain, provided information on pain self-management strategies, and were available in English. App contents were evaluated using an a priori 14-item self-management support (SMS-14) checklist. App quality was assessed using the 23-item Mobile Apps Rating Scale.

Results

Of the 939 apps screened, 19 apps met the inclusion criteria. Meditation and guided relaxation were the most frequently included self-management strategies. Overall, the included apps met a median of 4 (range 1-8) of the SMS-14 checklist. A total of 3 apps (Curable, PainScale-Pain Diary and Coach, and SuperBetter) met the largest number of items (8 out of 14) to foster self-management of pain. Self-monitoring of symptoms (n=11) and self-tailoring of strategies (n=9) were frequently featured functions, whereas a few apps had features facilitating social support and enabling communicating with clinicians. No apps provided information tailored to the cultural needs of the user. The app quality mean scores using Mobile Apps Rating Scale ranged from 2.7 to 4.5 (out of 5.0). Although use of 2 apps (Headspace and SuperBetter) has been shown to improve health outcomes, none of the included apps have been evaluated in people with persistent pain.

Conclusions

Of the 3 apps (Curable, PainScale-Pain Diary and Coach, and SuperBetter) that met the largest number of items to support skills in self-management of pain, 2 apps (PainScale-Pain Diary and Coach and SuperBetter) were free, suggesting the potential for using apps as a scalable, wide-reaching intervention to complement face-to-face care. However, none provided culturally tailored information. Although 2 apps (Headspace and SuperBetter) were validated to show improved health outcomes, none were tested in people with persistent pain. Both users and clinicians should be aware of such limitations and make informed choices in using or recommending apps as a self-management tool. For better integration of apps in clinical practice, concerted efforts are required among app developers, clinicians, and people with persistent pain in developing apps and evaluating for clinical efficacy.

The Relationship between Acculturation and Experimental Pain Sensitivity in Asian Americans with Knee Osteoarthritis

Multiple studies in healthy populations and clinical samples have shown that ethnic minorities have greater pain sensitivity than their majority counterparts. Acculturation is speculated to be one of the sociocultural factors contributing to pain sensitivity since cultural beliefs and practices can influence the way patients perceive and respond to pain. However, the relationship of acculturation to pain sensitivity in minority populations remains poorly understood. Therefore, in this cross-sectional study, we examined the relationship between acculturation and experimental pain sensitivity in 50 Asian Americans residing in North Central Florida with knee osteoarthritis pain. The Suinn-Lew Asian Self Identity Acculturation Scale was used to assess acculturation, and multimodal quantitative sensory testing was performed to measure experimental sensitivity, including heat pain tolerance, pressure pain threshold, and punctate mechanical pain. Descriptive and regression analyses were performed. Participants' mean age was 55.7 years, and about half of this sample were Korean American (56%). The participants had lived in the United States for 21 years on average. Regression analyses indicated that lower acculturation to American culture may contribute to greater experimental pain sensitivity. Asian Americans who were more acculturated to the American culture had higher heat pain tolerance (beta = 0.61, P=0.01), higher pressure pain threshold (beta = 0.59, P=0.02), and lower ratings of punctate mechanical pain (beta = -0.70, P < 0.01). These findings add to the literature regarding sociocultural factors associated with pain in Asian Americans; additional research with a larger and more diverse sample of Asian Americans is warranted for cross-validation.

Physical Therapy Approaches in the Treatment of Low Back Pain

Globally, in 2016, low back pain (LBP) contributed 57.6 million of total years lived with disability. Low Back Pain Guidelines regularly recommend the use of physical exercise for non-specific LBP. Early non-pharmacological treatment is endorsed. This includes education and self-management, and the recommencement of normal activities and exercise, with the addition of psychological programs in those whose symptoms persist. The aim of physical treatments is to improve function and prevent disability from getting worse. There is no evidence available to show that one type of exercise is superior to another, and participation can be in a group or in an individual exercise program. Active strategies such as exercise are related to decreased disability. Passive methods (rest, medications) are associated with worsening disability, and are not recommended. The Danish, United States of America, and the United Kingdom Guidelines recommend the use of exercise on its own, or in combination with other non-pharmacological therapies. These include tai chi, yoga, massage, and spinal manipulation. Public health programs should educate the public on the prevention of low back pain. In chronic low back pain, the physical therapy exercise approach remains a first-line treatment, and should routinely be used.