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Ryan CG, Karran EL, Wallwork SB, Pate JW, O'Keeffe M, Fullen BM, Livadas N, Jones N, Toumbourou JW, Gilchrist P, Cameron PA, Fatoye F, Ravindran D, Lorimer Moseley G. We Are All in This Together-Whole of Community Pain Science Education Campaigns to Promote Better Management of Persistent Pain. THE JOURNAL OF PAIN 2024; 25:902-917. [PMID: 37918470 DOI: 10.1016/j.jpain.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/02/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
Persistent pain is a major public health issue-estimated to affect a quarter of the world's population. Public understanding of persistent pain is based on outdated biomedical models, laden with misconceptions that are contrary to best evidence. This understanding is a barrier to effective pain management. Thus, there have been calls for public health-based interventions to address these misconceptions. Previous pain-focussed public education campaigns have targeted pain beliefs and behaviours that are thought to promote recovery, such as staying active. However, prevailing pain-related misconceptions render many of these approaches counter-intuitive, at best. Pain Science Education improves understanding of 'how pain works' and has been demonstrated to improve pain and disability outcomes. Extending Pain Science Education beyond the clinic to the wider community seems warranted. Learning from previous back pain-focussed and other public health educational campaigns could optimise the potential benefit of such a Pain Science Education campaign. Pain Science Education-grounded campaigns have been delivered in Australia and the UK and show promise, but robust evaluations are needed before any firm conclusions on their population impact can be made. Several challenges exist going forward. Not least is the need to ensure all stakeholders are involved in the development and implementation of Pain Science Education public messaging campaigns. Furthermore, it is crucial that campaigns are undertaken through a health equity lens, incorporating underrepresented communities to ensure that any intervention does not widen existing health inequalities associated with persistent pain. PERSPECTIVE: Public misconceptions about pain are a significant public health challenge and a viable intervention target to reduce the personal, social, and economic burden of persistent pain. Adaptation of Pain Science Education, which improves misconceptions in a clinical setting, into the public health setting seems a promising approach to explore.
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Affiliation(s)
- Cormac G Ryan
- Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK
| | - Emma L Karran
- Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Sarah B Wallwork
- Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Joshua W Pate
- Pain Education Team to Advance Learning (PETAL) Collaboration; Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Mary O'Keeffe
- Pain Education Team to Advance Learning (PETAL) Collaboration; Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, University of Sydney, Australia
| | - Brona M Fullen
- Pain Education Team to Advance Learning (PETAL) Collaboration; UCD School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | - Nick Livadas
- Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK
| | - Niki Jones
- Pain Education Team to Advance Learning (PETAL) Collaboration
| | - John W Toumbourou
- Pain Education Team to Advance Learning (PETAL) Collaboration; Deakin University, School of Psychology and Centre for Social and Early Emotional Development, Geelong, Australia
| | - Peter Gilchrist
- Pain Education Team to Advance Learning (PETAL) Collaboration; The University of Adelaide Rural Clinical School, Rural Generalist Program, South Australia
| | - Paul A Cameron
- Pain Education Team to Advance Learning (PETAL) Collaboration; Fife Health & Social Care Partnership, Scotland, UK; School of Medicine, Cardiff University, UK
| | - Francis Fatoye
- Pain Education Team to Advance Learning (PETAL) Collaboration; Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, UK; Lifestyle Disease Entity, North-West University, South Africa
| | - Deepak Ravindran
- Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK; Department of Pain Medicine, Royal Berkshire NHS Foundation Trust, UK
| | - G Lorimer Moseley
- Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
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Grøn S, Bülow K, Jonsson TD, Degn J, Kongsted A. What do people believe to be the cause of low back pain? A scoping review. Braz J Phys Ther 2023; 27:100562. [PMID: 37972538 PMCID: PMC10679815 DOI: 10.1016/j.bjpt.2023.100562] [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: 01/09/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To explore how causal beliefs regarding non-specific low back pain (LBP) have been quantitatively investigated. METHODS A scoping review based on the guidelines by the JBI (former Joanna Briggs Institute) was conducted. We searched Medline, Embase, Psychinfo, and CINAHL for relevant studies and included peer-reviewed original articles that measured causal beliefs about non-specific LBP among adults and reported results separate from other belief domains. RESULTS A total of 81 studies were included, of which 62 (77%) had cross sectional designs, 11 (14%) were cohort studies, 3 (4%) randomized controlled trials, 4 (5%) non-randomized controlled trials, and 1 (1%) case control. Only 15 studies explicitly mentioned cause, triggers, or etiology in the study aim. We identified the use of 6 questionnaires from which a measure of causal beliefs could be obtained. The most frequently used questionnaire was the Illness Perception Questionnaire which was used in 8 of the included studies. The studies covered 308 unique causal belief items which we categorized into 15 categories, the most frequently investigated being causal beliefs related to "structural injury or impairment", which was investigated in 45 (56%) of the studies. The second and third most prevalent categories were related to "lifting and bending" (26 studies [32%]) and "mental or psychological" (24 studies [30%]). CONCLUSION There is a large variation in how causal beliefs are measured and a lack of studies designed to investigate causal beliefs, and of studies determining a longitudinal association between such beliefs and patient outcomes. This scoping review identified an evidence gap and can inspire future research in this field.
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Affiliation(s)
- Søren Grøn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Chiropractic Knowledge Hub, Campusvej 55, 5230 Odense M, Denmark.
| | - Kasper Bülow
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Centre for Health and Rehabilitation, University College Absalon, Slagelse, Denmark
| | | | - Jakob Degn
- Independent researcher (chiropractic practice)
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Chiropractic Knowledge Hub, Campusvej 55, 5230 Odense M, Denmark
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Mankelow J, Ravindran D, Graham A, Suri S, Pate JW, Ryan CG, Martin D. An evaluation of a one-day pain science education event in a high school setting targeting pain related beliefs, knowledge, and behavioural intentions. Musculoskelet Sci Pract 2023; 66:102818. [PMID: 37418949 DOI: 10.1016/j.msksp.2023.102818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Persistent pain is a common condition affecting one in four UK adults. Public understanding of pain is limited. Delivering pain education within schools may improve public understanding in the longer term. OBJECTIVE To evaluate the impact of a one-day Pain Science Education (PSE) event on sixth form/high school students' pain beliefs, knowledge and behavioural intention. METHODS Exploratory, single-site, mixed-methods, single-arm study involving secondary school students ≥16 years old attending a one-day PSE event. Outcome measures included the Pain Beliefs Questionnaire (PBQ), Concepts of Pain Inventory (COPI-ADULT), a vignette to assess pain behaviours; and thematic analysis of semi-structured interviews. RESULTS Ninety (mean age 16.5 years, 74% female) of the 114 attendees, agreed to participate in the evaluation. PBQ scores improved on the Organic beliefs subscale [mean difference -5.9 (95% CI -6.8, -5.0), P < 0.01] and Psychosocial Beliefs subscale [1.6 (1.0, 2.2) P < 0.01]. The COPI-Adult revealed an improvement [7.1 (6.0-8.1) points, P < 0.01] between baseline and post intervention. Pain behavioural intentions improved post education for work, exercise, and bed rest related activities (p < 0.05). Thematic analysis of interviews (n = 3) identified increased awareness of chronic pain and its underpinning biology, beliefs that pain education should be widely available, and that pain management should be holistic. CONCLUSIONS A one-day PSE public health event can improve pain beliefs, knowledge and behavioural intentions in high school students and increase openness to holistic management. Future controlled studies are needed to confirm these results and investigate potential long-term impacts.
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Affiliation(s)
- J Mankelow
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK; Pain Education Team Aspiring Better Learning (PETAL), Australia; Pain Education Team Aspiring Better Learning (PETAL), UK.
| | - D Ravindran
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK; Royal Berkshire NHS Foundation Trust, UK; Pain Education Team Aspiring Better Learning (PETAL), Australia; Pain Education Team Aspiring Better Learning (PETAL), UK
| | - A Graham
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK
| | - S Suri
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK; NIHR Applied Research Collaboration for the North East and North Cumbria, Newcastle Upon Tyne, England, UK
| | - J W Pate
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia; Pain Education Team Aspiring Better Learning (PETAL), Australia; Pain Education Team Aspiring Better Learning (PETAL), UK
| | - C G Ryan
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK; Pain Education Team Aspiring Better Learning (PETAL), Australia; Pain Education Team Aspiring Better Learning (PETAL), UK
| | - D Martin
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK; NIHR Applied Research Collaboration for the North East and North Cumbria, Newcastle Upon Tyne, England, UK; Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Basnet R, Mendez DR, Lugo-González I, O'Hagan E, O'Keeffe M, Sharma S, Pate JW, Kennedy DS. Online information on chronic pain in 3 countries: an assessment of readability, credibility, and accuracy. Pain Rep 2023; 8:e1078. [PMID: 37342519 PMCID: PMC10278708 DOI: 10.1097/pr9.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives To assess the readability, credibility, and accuracy of online information on chronic pain in Australia, Mexico, and Nepal. Methods We assessed Google-based websites and government health websites about chronic pain for readability (using the Flesch Kincaid Readability Ease tool), credibility (using the Journal of American Medical Association [JAMA] benchmark criteria and Health on the Net Code [HONcode]), and accuracy (using 3 core concepts of pain science education: (1) pain does not mean my body is damaged; (2) thoughts, emotions, and experiences affect pain; and (3) I can retrain my overactive pain system). Results We assessed 71 Google-based websites and 15 government websites. There were no significant between-country differences in chronic pain information retrieved through Google for readability, credibility, or accuracy. Based on readability scores, the websites were "fairly difficult to read," suitable for ages 15 to 17 years or grades 10 to 12 years. For credibility, less than 30% of all websites met the full JAMA criteria, and more than 60% were not HONcode certified. For accuracy, all 3 core concepts were present in less than 30% of websites. Moreover, we found that the Australian government websites have low readability but are credible, and the majority provided all 3 core concepts in pain science education. A single Mexican government website had low readability without any core concepts but was credible. Conclusion The readability, credibility, and accuracy of online information on chronic pain should be improved internationally to support facilitating better management of chronic pain.
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Affiliation(s)
- Ritu Basnet
- Scheer Memorial Adventist Hospital, Benepa, Nepal
| | - David Ruiz Mendez
- Iztacala Faculty of Superior Studies, National Autonomous University of México, Tlalnepantla de Baz, Mexico
| | - Isaías Lugo-González
- Iztacala Faculty of Superior Studies, National Autonomous University of México, Tlalnepantla de Baz, Mexico
| | - Edel O'Hagan
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | - Mary O'Keeffe
- School of Public Health, Institute for Musculoskeletal Health, University of Sydney, Sydney, Australia
| | - Saurab Sharma
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Joshua W. Pate
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - David S. Kennedy
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Motion and Mobility Research Laboratory, University of Victoria, Victoria, BC, Canada
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Corline A, Cole F, Trewern L, Penlington C. 'Power to the People, to the people': Training for social prescribers improves support of persistent pain. Br J Pain 2023; 17:281-292. [PMID: 37342392 PMCID: PMC10278448 DOI: 10.1177/20494637231152979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Introduction Supported self-management is an important aspect of managing pain, however widely held beliefs about the biomedical nature of pain and limited time availability can make it a tricky concept to introduce to patients. Social prescribers are in an ideal position to support self-management of pain if appropriate training is available to support them. This study aimed to evaluate training for social prescribers and to explore their opinions and experiences about providing self-management support. Methods This was a mixed methods study. Repeated measures t-tests were used to compare the reported confidence of attendees in supporting different facets of self-management before and after the training. Thematic analysis of interviews was used to develop a deeper understanding of how participants related the training to their work with patients. Results Average confidence improved in all aspects of supporting self-management, and particularly with regard to supporting understanding pain, acceptance, pacing, setting goals, sleep and managing setbacks. Challenges were identified around explaining pain in an accurate and accessible way in order to provide a meaningful rationale for self-management. Conclusion Training for social prescribers in self-management support is feasible and leads to improvements in self-reported confidence. Further research is needed to determine the impact on patients and over a longer period of time.
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Affiliation(s)
- Alex Corline
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | | | - Louise Trewern
- Lead Lived Experience Trainer, Live Well with Pain, NHS Pain Service Volunteer Torbay and South Devon
| | - Chris Penlington
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
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A national media mass campaign improves beliefs and behaviours about low back pain in the general population and in general practitioners. Joint Bone Spine 2023; 90:105536. [PMID: 36708758 DOI: 10.1016/j.jbspin.2023.105536] [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: 10/03/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Previous international mass-media campaigns for low back pain (LBP) have had conflicting impacts on the general population. The objective was to evaluate the impact of a national back pain campaign conducted between 2017 and 2019 on beliefs and behaviours of general practitioners and the general population in France. METHODS Between 2017 and 2019, a mass-media campaign was used to disseminate positive messages about LBP using several media, along with a parallel campaign addressed to general practitioners. An email survey before the campaign and 6 and 18 months after the campaign started evaluated beliefs and behaviours among a representative sample of the 2 target populations (3500 people from the general population and 700 general practitioners before the campaign, and 2000 people and 300 general practitioners 6 and 18 months after). RESULTS Overall, 56% of the general population respondents before the campaign and 74% and 75% at 6 and 18 months after adhered to the statement "One should maintain physical activity" when dealing with LBP. Conversely, the percentage adhering to the statement "The best treatment is resting" decreased significantly from 68% before the campaign to 45% at 6 and 18 months after. Physicians reported delivering more reassurance and giving more documentation to patients after the campaign. They prescribed less sick leave during the first consultation (65% before the campaign, 46% and 30% at 6 and 18 months after). CONCLUSION A mass-media campaign aimed at the public and general practitioners in France significantly modified beliefs and behaviours about LBP.
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O'Keeffe M, Michaleff ZA, Harris IA, Buchbinder R, Ferreira GE, Zadro JR, Traeger AC, Thomas R, Belton J, Darlow B, Maher CG. Public and patient perceptions of diagnostic labels for non-specific low back pain: a content analysis. 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 2022; 31:3627-3639. [PMID: 36198841 DOI: 10.1007/s00586-022-07365-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/19/2022] [Accepted: 08/21/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE An online randomised experiment found that the labels lumbar sprain, non-specific low back pain (LBP), and episode of back pain reduced perceived need for imaging, surgery and second opinions compared to disc bulge, degeneration, and arthritis among 1447 participants with and without LBP. They also reduced perceived seriousness of LBP and increased recovery expectations. METHODS In this study we report the results of a content analysis of free-text data collected in our experiment. We used two questions: 1. When you hear the term [one of the six labels], what words or feelings does this make you think of? and 2. What treatment (s) (if any) do you think a person with [one of the six labels] needs? Two independent reviewers analysed 2546 responses. RESULTS Ten themes emerged for Question1. Poor prognosis emerged for disc bulge, degeneration, and arthritis, while good prognosis emerged for lumbar sprain, non-specific LBP, and episode of back pain. Thoughts of tissue damage were less common for non-specific LBP and episode of back pain. Feelings of uncertainty frequently emerged for non-specific LBP. Twenty-eight treatments emerged for Question2. Surgery emerged for disc bulge, degeneration, and arthritis compared to lumbar sprain, non-specific LBP, and episode of back pain. Surgery did not emerge for non-specific LBP and episode of back pain. CONCLUSION Our results suggest that clinicians should consider avoiding the labels disc bulge, degeneration and arthritis and opt for labels that are associated with positive beliefs and less preference for surgery, when communicating with patients with LBP.
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Affiliation(s)
- Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia.
| | | | - Ian A Harris
- Whitlam Orthopaedic Research Centre, South Western Sydney Clinical School, Ingham Institute for Applied Medical Research, The University of New South Wales, Sydney, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Joshua R Zadro
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Rae Thomas
- Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | | | - Ben Darlow
- Department of Primary Healthcare and General Practice, University of Otago, Wellington, New Zealand
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
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Management of people with low back pain: a survey of opinions and beliefs of Dutch and Belgian chiropractors. Chiropr Man Therap 2022; 30:29. [PMID: 35725617 PMCID: PMC9208165 DOI: 10.1186/s12998-022-00437-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Chiropractors commonly provide care to people with low-back pain (LBP). The aim of this survey was to determine the opinions and beliefs of chiropractors regarding the support and management of LBP. We also investigated whether their management is in accordance with the three most commonly recommended approaches to LBP based upon international guidelines (i.e. advice regarding return-to-work, limit bedrest, and stay active). Methods A web-based survey was sent out in 2013 to collect data from registered Dutch and Belgian chiropractors. In addition to providing a description of their sociodemographic and practice characteristics, chiropractors were asked to complete six patient vignettes representing people with LBP who typically present to a chiropractor. The respondents indicated which intervention(s) they would recommend or undertake. Based upon these vignettes, we were able to determine whether their management approach adhered to clinical guidelines. Generalized mixed models were used to explore guidelines adherence and their relationship to chiropractors’ characteristics. Results In total, 60% (n = 203/340) of the chiropractors who were invited, chose to participate. Chiropractors reported applying a chiropractic adjustment in 90% of all vignettes, while the advice to exercise varied from one-third in the chronic cases to approximately half of those with acute LBP. More than 75% of the chiropractors would initially treat LBP 1–2 times a week. More than 90% of the chiropractors advised against bedrest. Overall, self-reported adherence to clinical guidelines for all six vignettes was [64.5% (CI 58.7–70.0)]. Adherence in the chronic vignettes [73.4% (CI 66.7–79.2)] was better than in the acute vignettes [55.9% (CI 50.5–61.1)]. Importantly, regarding recommended approaches to LBP, chiropractors more consistently followed guidelines regarding advice to limit bedrest [98.5% (CI 97.3–99.1)] than advice to stay active [77.5% (CI 72.3–81.9)] or return-to-work [59.4% (CI 55.2–63.4)]. Finally, Dutch chiropractors were more likely to adhere to the guidelines than Belgian chiropractors. Conclusions Chiropractic adjustments were the most common self-reported treatment modalities supplemented by exercise in the management of LBP patients. Two-thirds of the chiropractors reported adhering to the guidelines regarding management and advice for LBP patients. Practitioners should improve guideline adherence, particularly for acute LBP cases, and when advising on return-to-work. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00437-1.
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Naye F, Décary S, Tousignant-Laflamme Y. Development and content validity of a rating scale for the pain and disability drivers management model. Arch Physiother 2022; 12:14. [PMID: 35570310 PMCID: PMC9107946 DOI: 10.1186/s40945-022-00137-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Establishing the biopsychosocial profile of patients with low back pain (LBP) is essential to personalized care. The Pain and Disability Drivers Management model (PDDM) has been suggested as a useful framework to help clinicians establish this biopsychosocial profile. Yet, there is no tool to facilitate its integration into clinical practice. Thus, the aim of this study is to develop a rating scale and validate its content, to rapidly establish the patient’s biopsychosocial profile, based on the five domains of the PDDM. Methods The tool was developed in accordance with the principles of the COSMIN methodology. We conducted three steps: 1) item generation from a comprehensive review, 2) refinement of the scale with clinicians’ feedback, and 3) statistical analyses to assess content validity. To validate the item assessing with Likert scales, we performed Item level-Content Validity Index (I-CVI) analyses on three criteria (clarity, presentation and clinical applicability) with an a priori threshold of > 0.78. We conducted Average-Content Validity Index (Ave-CVI) analyses to validate the overall scale with a threshold of > 0.9. Results In accordance with the PDDM, we developed a 5-item rating scale (1 per domain) with 4 score options. We selected clinical instruments to screen for the presence or absence of problematic issues within each category of the 5 domains. Forty-two participants provided feedback to refine the scale’s clarity, presentation, and clinical applicability. The statistical analysis of the latest version presented I-CVI above the threshold for each item (I-CVI ranged between 0.94 and 1). Analysis of the overall scale supported its validation (Ave-CVI = 0.96 [0.93;0.98]). Conclusion From the 51 biopsychosocial elements contained within the 5 domains of the PDDM, we developed a rating scale that allows to rapidly screen for problematic issues within each category of the PDDM’s 5 domains. Involving clinicians in the process allowed us to validate the content of the first scale to establish the patient’s biopsychosocial profile for people with low back pain. Future steps will be necessary to continue the psychometric properties analysis of this rating scale. Supplementary Information The online version contains supplementary material available at 10.1186/s40945-022-00137-2.
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Affiliation(s)
- Florian Naye
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Qc, J1H 5N4, Canada
| | - Simon Décary
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Qc, J1H 5N4, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Qc, J1H 5N4, Canada. .,Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Qc, J1H5N4, Canada.
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Wang X, Song WJ, Ruan Y, Li BC, Lü C, Huang N, Fang FF, Gu W. Core muscle functional strength training for reducing the risk of low back pain in military recruits: An open-label randomized controlled trial. JOURNAL OF INTEGRATIVE MEDICINE 2022; 20:145-152. [PMID: 34969649 DOI: 10.1016/j.joim.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/26/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Core muscle functional strength training (CMFST) has been reported to reduce injuries to the lower extremity. However, no study has confirmed whether CMFST can reduce the risk of low back pain (LBP). OBJECTIVE This study identified the effects of CMFST on the incidence of LBP in military recruits. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION We performed a prospective, open-label, randomized, controlled study in a population of young healthy male naval recruits from a Chinese basic combat training program. Participants were randomly assigned to either the core group or the control group. In additional to normal basic combat training, recruits in the core group underwent a CMFST program for 12 weeks, while recruits in the control group received no extra training. MAIN OUTCOME MEASURES At the beginning of the study and at the 12th week, the number of participants with LBP was counted, and lumbar muscle endurance was measured. In addition, when participants complained of LBP, they were assessed using the visual analog scale (VAS) and Roland Morris Disability Questionnaire (RMDQ). RESULTS A total of 588 participants were included in the final analysis (295 in the core group and 293 in the control group). The incidence of LBP in the control group was about twice that of the core group over the 12-week study (20.8% vs 10.8%, odds ratio: 2.161-2.159, P < 0.001). The core group had better lumbar muscle endurance at 12 weeks than the control group ([200.80 ± 92.98] s vs [147.00 ± 84.51] s, P < 0.01). There was no significant difference in VAS score between groups, but the core group had a significantly lower RMDQ score at week 12 than the control group (3.33 ± 0.58 vs 5.47 ± 4.41, P < 0.05). CONCLUSION This study demonstrated that the CMFST effectively reduced the incidence of LBP, improved lumbar muscle endurance, and relieved the dysfunction of LBP during basic military training.
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Affiliation(s)
- Xin Wang
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China
| | - Wen-Juan Song
- Department of Rehabilitation, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Yi Ruan
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China
| | - Bing-Chu Li
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Can Lü
- Department of Rehabilitation, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Nian Huang
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China
| | - Fan-Fu Fang
- Department of Rehabilitation, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
| | - Wei Gu
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China.
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11
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Demoulin C, Gabriel L, Nève de Mévergnies O, Henket L, Roussel N, Goubert L, Vanderthommen M, Pitance L. Several low back pain-related misbeliefs are still around in 2020: A cross-sectional survey in Belgium. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 27:e1927. [PMID: 34706135 DOI: 10.1002/pri.1927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/09/2021] [Accepted: 10/09/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Low back pain (LBP)-related misbeliefs are known to be among risk factors for LBP chronification and for persistence of chronic pain. The main objective of this study was to investigate the current LBP-related beliefs in the general population in Belgium, considering the fact that the last survey in Belgium about the topic was conducted more than 15 years ago. METHODS A cross-sectional study design was used. Belgian adults (>17 years old) were recruited in the three regions of the country by means of non-probabilistic recruitment methods. Participants were invited to fill in a battery of questionnaires including demographic questions as well as questions about their LBP history and the LBP Beliefs Questionnaire (LBPBQ). RESULTS A total of 3724 individuals participated in the study. The LBPBQ scores indicated several LBP-related misbeliefs. About 15%-25% of participants still think that imaging tests can always identify the cause of pain and that bed rest is the mainstay of therapy. The majority of the participants think that "unnecessary" movements should be avoided when having LBP (58% of the respondents), and that they should "take it easy" until the pain goes away (69%). Most respondents also had maladaptive/wrong expectations, for example, a systematic worsening with time (65%) and a need for surgery in case of disc herniation (54%). CONCLUSIONS The present study suggests that in 2020 several LBP-related misbeliefs are still current in Belgium, particularly regarding the vulnerability of the spine. Therefore, further efforts to improve LBP-related beliefs/knowledge in the general population are necessary.
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Affiliation(s)
- Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium.,Spine Clinics, Liege University Hospital Center, Liege, Belgium.,Faculty of Motor Sciences, UCLouvain, Université Catholique de Louvain-La-Neuve, Louvain, Belgium
| | - Laura Gabriel
- Faculty of Motor Sciences, UCLouvain, Université Catholique de Louvain-La-Neuve, Louvain, Belgium
| | | | - Laura Henket
- Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium
| | - Nathalie Roussel
- Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Marc Vanderthommen
- Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium.,Spine Clinics, Liege University Hospital Center, Liege, Belgium
| | - Laurent Pitance
- Faculty of Motor Sciences, UCLouvain, Université Catholique de Louvain-La-Neuve, Louvain, Belgium
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12
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Suhail A, Slathia S, Quais S, Poulter DC. Do “Myths” of low back pain exist among young Indian college-going adults with a history of low back pain? A cross-sectional study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00036-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Abstract
Background
Low back pain (LBP) is a prominent public health problem which causes disability around the globe. The prevalence of LBP is on the rise in lower to middle-income countries. India has a varied prevalence of LBP among the rural as well as urban population ranging from 6.2 to 92%. There has been a marked increase in young adults getting LBP with a proportion converting to chronic LBP later in life. Beliefs associated with any disorder affect the course, management, and need for imaging studies. Negative beliefs about LBP in any population may lead to unnecessary psychologic distress and an increase in disease burden. Focusing these negative beliefs on the younger population can help curb the chronicity and lessen the disability caused by it. This cross-sectional study explored the presence of myths in 516 college-going Indian young adults from Lovely Professional University.
Results
A total of 516 individuals participated in the study. The mean (SD) age of the participants was 22.69 years (2.417). Among them, 47.5% (245) were females and 52.5% (271) were males. The findings show that a high percentage of college-going young adults have false beliefs in most of the ten domains (myths) explored. The most prevalent myths were “LBP is caused by weak ‘core’ muscles and having a strong core protects against future LBP” (81.2%) and “LBP is caused by poor posture when sitting, standing, and lifting” with 80.6% agreeing to it.
Conclusion
Our study demonstrated that the myths of low back pain are widespread among the studied population. The findings suggest that community education programs must be developed to address these myths, hence reducing the disease burden associated with back pain.
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Lumbar Intradiscal Ozone Chemonucleolysis Applied Together with the Epidural Steroid Treatment. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:203-209. [PMID: 34349597 PMCID: PMC8298084 DOI: 10.14744/semb.2020.55649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/22/2020] [Indexed: 11/20/2022]
Abstract
Objectives: Intradiscal ozone treatment is a minimally-invasive method that can be applied to patients who have low back pain and do not respond to conservative treatment. This retrospectively designed study aimed to evaluate its clinical efficacy, adverse effects, or complication rates. Methods: Patients with lumbar degenerative disc disease (LDDD) who underwent intradiscal O2-O3 treatment between January 2016 and April 2018 were included in the study. Pain and disability levels were assessed at pre-injection, 1-month and 1-year post-injection periods using visual analog scale (VAS) and Oswestry Disability Index (ODI), respectively. Results: A total of 520 patients (270 males and 250 females) with the mean age of 38.9±5.7 years included in the study. First-month and 1st-year post-injection VAS and ODI scores were significantly lower than pre-injection scores (p<0.001). Remarkable VAS score reduction (more than 50%) was found in 60.2% of patients at 1st month and in 52.9% of patients at the 1st year. No important side effects recorded. Conclusion: Intradiscal ozone therapy applied together with the epidural steroid treatment, one of the percutaneous application techniques for the treatment of low back pain related to LDDD, has successful outcomes, clinical efficacy, and low rate of side effects, and thus, is one of the methods that should be considered before surgery when appropriate patients.
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14
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Prevalence and Factors Associated with Musculoskeletal Disorders among Secondary Schoolteachers in Hail, Saudi Arabia: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126632. [PMID: 34203032 PMCID: PMC8296446 DOI: 10.3390/ijerph18126632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 12/02/2022]
Abstract
Musculoskeletal disorders (MSDs) are one of the most common occupational health hazards and serious health concerns among teachers. About 39% to 95% of teachers suffer from musculoskeletal pain that can lead to a decline in their performance, frequent sick leaves and early retirement, and can have a negative impact on their quality of life. The aim of this study was to investigate the prevalence of and risk factors for MSDs among secondary schoolteachers in Hail, Saudi Arabia. A cross-sectional study was conducted through an electronic survey. A self-reported and validated Arabic version of the Nordic Musculoskeletal Questionnaire (NMQ) was used. Participants were recruited randomly through a two-stage sampling technique. A total of 251 respondents (57.8% males and 42.2% females) returned the questionnaire. The overall prevalence of MSDs was 87.3%. Female teachers (95.3%) suffered more than their male counterparts (81.4%). The most common site was the lower back (62.55%), followed by the shoulders (53.39%) and knees (41.04%). Most of the participants (72.7%) reported MSDs in multiple sites. Binomial logistic regression predicted that smoking is a significant risk factor for lower back disorders (p < 0.05). A high prevalence of MSDs can be due to a substantial lack of awareness and practice of ergonomics, which warrant the development of preventive strategies and educational programs.
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Sharma S, Ferreira-Valente A, de C Williams AC, Abbott JH, Pais-Ribeiro J, Jensen MP. Group Differences Between Countries and Between Languages in Pain-Related Beliefs, Coping, and Catastrophizing in Chronic Pain: A Systematic Review. PAIN MEDICINE 2021; 21:1847-1862. [PMID: 32044980 PMCID: PMC7553014 DOI: 10.1093/pm/pnz373] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Saurab Sharma
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | | | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - José Pais-Ribeiro
- William James Center for Research, ISPA - University Institute, Lisbon, Portugal
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Nolan D, Sharpe N, O'Sullivan K, Stephenson J, O'Sullivan P, Lucock M. What are the back beliefs of NHS employees, and does manual handling training influence them. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1873417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- David Nolan
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Nicky Sharpe
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | | | - John Stephenson
- Department of Health Sciences, University of Huddersfield, Huddersfield, United Kingdom of Great Britain and Northern Ireland
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- Shenton Park, Body Logic Physiotherapy Clinic, Perth, Australia
| | - Mike Lucock
- Centre for Applied Research in Health, University of Huddersfield, Huddersfield, United Kingdom of Great Britain and Northern Ireland
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom of Great Britain and Northern Ireland
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17
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Adams MS, Lotz JC, Diederich CJ. In silico feasibility assessment of extracorporeal delivery of low-intensity pulsed ultrasound to intervertebral discs within the lumbar spine. Phys Med Biol 2020; 65:215011. [PMID: 32620003 DOI: 10.1088/1361-6560/aba28d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Low intensity pulsed ultrasound (LIPUS) may have utility for non-invasive treatment of discogenic lower back pain through stimulating, remodeling and accelerating healing of injured or degenerated intervertebral disc (IVD) tissues. This study investigates the feasibility of delivering LIPUS to lumbar IVDs between L2 and S1 spine vertebra using a planar extracorporeal phased array (8 × 8 cm, 1024 elements, 500 kHz). Three 3D anatomical models with heterogenous tissues were generated from patient CT image sets and used in the simulation-based analysis. Time-reversal acoustic modeling techniques were applied to optimize posterior-lateral placement of the array with respect to the body to facilitate energy deposition in discrete target regions spanning the annulus fibrosus and central nucleus of each IVD. Forward acoustic and biothermal simulations were performed with time-reversal optimized array placements and driving amplitude/phase settings to predict LIPUS intensity distributions at target sites and to investigate off-target energy deposition and heating potential. Simulation results demonstrate focal intensity gain of 5-168 across all IVD targets and anatomical models, with greater average intensity gain (>50) and energy localization in posterior, posterolateral, and lateral target sites of IVDs. Localized LIPUS delivery was enhanced in thinner patient anatomies and in the high lumbar levels (L2-L3 and L3-L4). Multiple amplitude/phasing illumination patterns could be sequenced at a fixed array position for larger regional energy coverage in the IVD. Biothermal simulations demonstrated that LIPUS-appropriate exposures of 100 mW cm-2 ISPTA to the target disc region would result in <1 °C global peak temperature elevation for all cases. Hence, simulations suggest that spatially-precise extracorporeal delivery of therapeutically relevant LIPUS doses to discrete regions of lumbar IVDs is feasible and may be useful in clinical management of discogenic back pain.
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Affiliation(s)
- Matthew S Adams
- Thermal Therapy Research Group, Department of Radiation Oncology, University of California San Francisco, 2340 Sutter Street, S341, San Francisco, CA 94115, United States of America
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Beliefs and attitudes about low back pain in Argentina: A cross-sectional survey using social media. Musculoskelet Sci Pract 2020; 49:102183. [PMID: 32861356 DOI: 10.1016/j.msksp.2020.102183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND low back pain (LBP) is highly prevalent, very disabling and carries an enormous economic burden. The multifactorial nature of LBP often does not allow identification of a single pathoanatomic driver of pain. Unhelpful beliefs are associated with elevated levels of pain and may have a negative impact on the recovery of an episode of LBP. Beliefs about the back and back pain have not been evaluated in the Argentine general population. OBJECTIVE to assess the beliefs about the back and back pain of the Argentine population. The secondary objective was to compare the beliefs between respondents with and without LBP and between those who had and had not seen a health care professional (HCP). STUDY DESIGN cross-sectional study. METHOD we included Argentinians aged 18 years or more with or without LBP. The Argentine version of Back Pain Attitudes Questionnaire (Back-PAQ) was used to assess back beliefs. RESULTS one thousand and ninety-two participants responded the survey. Current LBP was reported by 42.3% (95% CI 39.3-45.2) of respondents and the life-time prevalence was 88.4% (95% CI 82.6-94.5). The mean Back-PAQ score was 111.7 (95% CI 111-112.5). Significant differences were found when comparing means scores of the current pain group with past and never LBP groups (p < 0.001). There were no difference in mean scores between respondents who were and were not exposed to a HCP. CONCLUSION Survey respondents sampled from the Argentine population had in general negative beliefs about back pain. Respondents with current pain had more unhelpful beliefs than pain free respondents in relation to the prognosis and recovery of an episode of LBP. Small differences were found in the beliefs of respondents who had received care for LBP from a HCP and those who did not seek care.
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Abstract
Pain is considered a hardwired signal of bodily disturbance belonging to a basic motivational system that urges the individual to act and to restore the body's integrity, rather than just a sensory and emotional experience. Given its eminent survival value, pain is a strong motivator for learning. Response to repeated pain increases when harm risks are high (sensitization) and decreases in the absence of such risks (habituation). Discovering relations between pain and other events provides the possibility to predict (Pavlovian conditioning) and control (operant conditioning) harmful events. Avoidance is adaptive in the short term but paradoxically may have detrimental long-term effects. Pain and pain-related responses compete with other demands in the environment. Exposure-based treatments share the aim of facilitating or restoring the pursuit of individual valued life goals in the face of persistent pain, and further improvements in pain treatment may require a paradigm shift toward more personalized approaches.
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Affiliation(s)
- Johan W S Vlaeyen
- Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, 3000 Leuven, Belgium; .,Experimental Health Psychology, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, 9000 Ghent, Belgium.,Centre for Pain Research, University of Bath, Bath BA2 7AY, United Kingdom
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20
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Crombez G, De Paepe AL, Veirman E, Eccleston C, Verleysen G, Van Ryckeghem DM. Let's talk about pain catastrophizing measures: an item content analysis. PeerJ 2020; 8:e8643. [PMID: 32181053 PMCID: PMC7060750 DOI: 10.7717/peerj.8643] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Concerns have been raised about whether self-report measures of pain catastrophizing reflect the construct as defined in the cognitive-behavioral literature. We investigated the content of these self-report measures; that is, whether items assess the construct 'pain catastrophizing' and not other theoretical constructs (i.e., related constructs or pain outcomes) using the discriminant content validity method. METHOD Items (n = 58) of six pain catastrophizing measures were complemented with items (n = 34) from questionnaires measuring pain-related worrying, vigilance, pain severity, distress, and disability. Via an online survey, 94 participants rated to what extent each item was relevant for assessing pain catastrophizing, defined as "to view or present pain or pain-related problems as considerably worse than they actually are" and other relevant constructs (pain-related worrying, vigilance, pain severity, distress, and disability). RESULTS Data were analyzed using Bayesian hierarchical models. The results revealed that the items from pain-related worrying, vigilance, pain severity, distress, and disability questionnaires were distinctively related to their respective constructs. This was not observed for the items from the pain catastrophizing questionnaires. The content of the pain catastrophizing measures was equally well, or even better, captured by pain-related worrying or pain-related distress. CONCLUSION Based upon current findings, a recommendation may be to develop a novel pain catastrophizing questionnaire. However, we argue that pain catastrophizing cannot be assessed by self-report questionnaires. Pain catastrophizing requires contextual information, and expert judgment, which cannot be provided by self-report questionnaires. We argue for a person-centered approach, and propose to rename 'pain catastrophizing' measures in line with what is better measured: 'pain-related worrying'.
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Affiliation(s)
- Geert Crombez
- Deparment of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Annick L. De Paepe
- Deparment of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Elke Veirman
- Deparment of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | | | - Gregory Verleysen
- Ghent University, Research Support Office, Faculty of Psychology and Educational Sciences, Ghent, Belgium
| | - Dimitri M.L. Van Ryckeghem
- Deparment of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Experimental Health Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Institute for Health and Behaviour, INSIDE, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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Cresswell C, Galantino ML, Myezwa H. The prevalence of fear avoidance and pain catastrophising amongst patients with chronic neck pain. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1326. [PMID: 32161823 PMCID: PMC7059507 DOI: 10.4102/sajp.v76i1.1326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 11/14/2019] [Indexed: 11/20/2022] Open
Abstract
Background Cognitive factors impact chronic pain, but the prevalence of fear avoidance (FA) and pain catastrophising (PC) in individuals suffering from chronic neck pain (CNP) has not been investigated in South Africa. Objectives To determine the prevalence of FA and PC in patients with CNP at private physiotherapy practices in Johannesburg. Method The Tampa Scale for Kinesiophobia-11 (TSK-11) (α = 0.80) and Pain Catastrophising Scale (α = 0.87) self-report questionnaires were used in a cross-sectional study to determine the prevalence of FA and PC, respectively. Descriptive statistics and correlations using Pearson’s or Spearman’s coefficient were conducted between demographic variables and FA and PC. Non-parametric data were tested using the Wilcoxon rank-sum or Kruskal–Wallis test. Cohen’s d-value or r-value measured strength of associations. Results A sample of 106 CNP patients with a mean age of 48.7 years (± 14.8) from 25 randomly selected private practices participated in the study. Of the participants, 81% were women (n = 86). Fear avoidance and PC had a prevalence of 25.5% (n = 27) and 15.1% (n = 16), respectively. A positive correlation was found between FA-11-Total and PC-Total (r = 0.684; p = 0.0001) and between FA (TSK-11-Total and TSK-SF (somatic focus)) and PC and its subscales (r ≥ 0.602; p = 0.0001). Participants with a secondary education (26.0 ± 3.4) showed a higher FA than those with tertiary education (21.9 ± 1.5). Effect size was moderate (Cohen’s d = 0.60). Pain intensity correlated positively with both FA (Pearson’s correlation: r = 0.33; p = 0.001) and PC (Spearman’s correlation; r = 0.39; p = 0.0001). Conclusion FA and PC affect a number of patients with CNP. A lower level of education was associated with FA and a higher pain intensity was associated with higher FA and PC. Clinical implications Identifying FA and PC in patients with CNP is important to facilitate holistic management.
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Affiliation(s)
- Clare Cresswell
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary L Galantino
- School of Health Sciences, Stockton University, Galloway, United States
| | - Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
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ÖZEL ASLIYÜCE Y, GÖKMEN D, ÜLGER Ö. Rasch analysis of the Neck Bournemouth Questionnaire: Turkish version, validity, and reliability study. Turk J Med Sci 2019; 49:1760-1765. [PMID: 31731331 PMCID: PMC7518667 DOI: 10.3906/sag-1907-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/03/2019] [Indexed: 11/03/2022] Open
Abstract
Background/aim The multidimensional evaluation of patients with chronic neck pain is important for planning the treatment program. The aim of this study was to investigate the validity and reliability of the Turkish version of the Neck Bournemouth Questionnaire (NBQ). Materials and methods The internal construct validity of the NBQ was examined by the fit of the data to the Rasch measurement model. External validity of the NBQ was evaluated by testing for expected associations of Rasch transformed NBQ score with the corresponding variables through the process of convergent validity. The reliability of the NBQ in terms of both internal consistency and test-retest reliability was assessed by the person separation index (PSI) and differential item functioning (DIF) by time effect. Results It was determined that the questionnaire has 2 factors. None of the items of Factor 1 (F1) and Factor 2 (F2) showed DIF. The reliability of F1 (Cronbach’s alpha = 0.89, PSI = 0.87) and F2 (Cronbach’s alpha = 0.77, PSI = 0.87) was good with Cronbach’s alpha and PSI. There was a good correlation between NBQ/F1 and the Neck Disability Index (NDI) (r = 0.673) and Neck Pain and Disability Scale (NPDS) (r = 0.709). Also, there was a correlation between NBQ/F2 and the Beck Depression Inventory (BDI) (r = 0.552) and Beck Anxiety Inventory (BAI) (r = 0.410). Conclusion The Turkish version of the Neck Bournemouth Questionnaire is valid and reliable.
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Affiliation(s)
- Yasemin ÖZEL ASLIYÜCE
- Faculty of Physiotherapy and Rehabilitation, Hacettepe University, AnkaraTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Derya GÖKMEN
- Department of Biostatistics, Faculty of Medicine, Ankara University, AnkaraTurkey
| | - Özlem ÜLGER
- Faculty of Physiotherapy and Rehabilitation, Hacettepe University, AnkaraTurkey
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Du ZC, Zhu LX. A Heterologous Fibrin Glue Enhances the Closure Effect of Surgical Suture on the Repair of Annulus Fibrous Defect in a Sheep Model. Curr Med Sci 2019; 39:597-603. [PMID: 31346996 DOI: 10.1007/s11596-019-2079-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/25/2019] [Indexed: 12/20/2022]
Abstract
Improving the closure effect of surgical suture for repair of annulus fibrosus defects remains an unsolved problem. A new type of porcine fibrin glue was reported for the repair of annulus fibrous defects in sheep models in this study. Continuous axial loading test showed that this glue could effectively improve the closure effect of surgical suture for annulus fibrous defect. Magnetic resonance imaging (MRI) of the lumbar spine confirmed that, compared with non-fibrin glue treated intervertebral discs, it contributed to preservation of the nucleus pulposus and maintained the physiological hydration of the intervertebral discs. Moreover, histomorphology evaluation showed that the porcine fibrin glue could partially reverse degeneration of the injured intervertebral discs. Taken together, porcine fibrin glue can effectively enhance the closure effect of surgical suture on annulus fibrosus, improve the repair effect and slow down the degeneration of the intervertebral disc, and provide a potential therapeutic strategy for degenerative intervertebral disc disease.
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Affiliation(s)
- Zhi-Cai Du
- Southern Medical University, Guangzhou, 510515, China.,Department of Minimally Invasive Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010030, China
| | - Li-Xin Zhu
- Southern Medical University, Guangzhou, 510515, China. .,Department of Orthopaedic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China.
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McCabe E, Jadaan D, Munigangaiah S, Basavaraju N, McCabe JP. Do medical students believe the back pain myths? A cross-sectional study. BMC MEDICAL EDUCATION 2019; 19:235. [PMID: 31248406 PMCID: PMC6598342 DOI: 10.1186/s12909-019-1676-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/19/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Low back pain (LBP) is common, affecting 58-84% of adults at some point. In benign cases, misinformation can lead to harmful coping strategies and prolonged recovery time. Deyo has identified seven 'Myths of Back Pain' as misconceptions commonly seen in clinical practice of which doctors-in-training should be aware. We sought to determine medical students' baseline knowledge of the prognosis and management of LBP compared to the general public and to dispel the 'Myths of Back Pain'. METHODS We carried out a cross-sectional study of medical students (pre-clinical and clinical) at the National University of Ireland, Galway where students completed a questionnaire outlining the seven 'Myths of Back Pain'. Final year students completed the survey before and after a seminar on LBP. Students' results were compared with a random sample of the public who attended Galway University Hospital. RESULTS Two hundred nineteen students completed the questionnaire (59% female, 41% male). The mean age was 21 years (17-32). The mean number of correct answers increased according to medical school year (premedical 3/7, first year 4/7, final year 5/7). A personal history of back pain and female sex were associated with higher scores. On average, medical students answered 4/7 questions correctly overall, compared to the public (n = 131) who averaged at 3/7. Final years dispelled one further myth after their LBP seminar. CONCLUSIONS Common misconceptions around LBP are prevalent among medical students and the general public. It is important that medical school curricula address these issues as part of their musculoskeletal programme.
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Affiliation(s)
- Eva McCabe
- School of Medicine, National University of Ireland, Galway, Ireland.
| | - Dima Jadaan
- School of Medicine, National University of Ireland, Galway, Ireland
| | | | - Navya Basavaraju
- Department of Radiation Oncology, University Hospital Galway, Galway, Ireland
| | - John P McCabe
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway, Galway, Ireland
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Horn-Hofmann C, Trost Z, Hublet A, Mrug S, Van Damme J, Vervoort T. The Relationship Between Pain Severity and Alcohol Use Among School-Aged Children and Adolescents: The Moderating Role of Drinking Motives. PAIN MEDICINE 2019; 19:284-296. [PMID: 28340189 DOI: 10.1093/pm/pnx016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Evidence from adult samples suggests a co-occurrence between pain and alcohol abuse. However, studies in adolescents are scarce and results are inconsistent, with some studies observing heightened and others observing reduced alcohol consumption in adolescents suffering from pain. We hypothesized that in adolescents the association between pain and alcohol use will be moderated by drinking motives. Methods Data from a large representative sample of Flemish school children and adolescents (N = 10,650, 50.8% boys, age range = 10-21 years, Mage = 14.33 years) were collected as part of the World Health Organization collaborative Health Behaviour in School-Aged Children (HBSC) survey. Pain severity was graded based on a pediatric pain classification system that accounts for both pain intensity and disability. Alcohol consumption was operationalized using two variables: frequency of drinking and drunkenness. The Drinking Motives Questionnaire-Revised was used to capture drinking motives; it assesses four motive categories (enhancement, coping, social, and conformity). Results Findings indicated that higher pain severity was associated with greater frequency of alcohol use and drunkenness. However, drinking motives moderated this association. The positive association between pain severity and drinking frequency was stronger in case of high conformity motives. Likewise, the association between pain severity and drunkenness frequency was stronger at high levels of conformity motives and reached significance only at high levels of coping motives. Conclusions Our findings suggest that specific drinking motives are linked to problematic alcohol use in adolescents with pain. Future studies using a longitudinal design are needed to draw conclusions about direction of effects.
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Affiliation(s)
| | - Zina Trost
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Sylvie Mrug
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Tine Vervoort
- Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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Scott-Young M, McEntee L, Furness J, Schram B, Hing W, Grosser D, Zotti M. Combined Aorto-Iliac and Anterior Lumbar Spine Reconstruction: A Case Series. Int J Spine Surg 2018; 12:328-336. [PMID: 30276089 PMCID: PMC6159654 DOI: 10.14444/5038] [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: 02/06/2023] Open
Abstract
BACKGROUND Treatment options for aortic-iliac pathology may include endovascular repair and open surgical repair. Treatment options for degenerative disc disease (DDD) are varied but commonly include anterior reconstruction. When both the aortic-iliac and spinal pathologies are significant and surgical intervention is indicated for each pathology, the opportunity exists for concurrent treatment of both the aortic-iliac pathology and DDD in the same operation. The purpose of this case series was to document the safety and feasibility of a surgical strategy whereby a combined elective reconstructive procedure was performed for aortic and anterior lumbar spinal pathologies. METHODS The case histories of 5 patients who were treated for both spinal and vascular pathology are presented. Surgical outcome measures included operative time, blood loss, length of stay, and complications. Spine-specific outcome measures included Oswestry Disability Index, Roland Morris Disability Questionnaire, and visual analogue scores (back and leg). RESULTS The spinal reconstructions performed included 1 L4-5 total disc replacement (TDR), 1 L4-5, L5-S1 anterior lumbar interbody fusion (ALIF), 1 L5-S1 ALIF, and 2 hybrid procedures (L4-5 TDR with L5-S1 ALIF). Vascular reconstructions included 4 aorto-bi-iliac bypass grafts and 1 aortic tube graft. The average operative time was 365 minutes (ranging between 330 and 510 minutes), the average blood loss was 1699 mL (range between 1160 and 2960 mL), and the average length of hospital stay was 14 days (range from 8 to 22 days). There were no in-hospital complications, and all patients experienced significant improvement in both back and leg pain. One patient developed kinking of the iliac limbs of the vascular graft 1 year postoperatively, which was managed with endovascular stenting of the graft. CONCLUSIONS Aortic-iliac pathology and DDD are significant pathologies often treated in isolation. This study illustrates that, despite its complexity, highly trained individuals in a specialized setting can perform combined surgery to achieve a satisfactory outcome for the patient. LEVEL OF EVIDENCE Level IV evidence.
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Affiliation(s)
- Matthew Scott-Young
- Bond University, Faculty of Health Science and Medicine, Gold Coast, Queensland, Australia
- Bond University, Faculty of Health Science and Medicine, Gold Coast, Queensland, Australia
| | - Laurence McEntee
- Bond University, Faculty of Health Science and Medicine, Gold Coast, Queensland, Australia
- Gold Coast Spine, Gold Coast, Queensland, Australia
| | - James Furness
- Bond University, Faculty of Health Science and Medicine, Gold Coast, Queensland, Australia
| | - Ben Schram
- Bond University, Faculty of Health Science and Medicine, Gold Coast, Queensland, Australia
| | - Wayne Hing
- Bond University, Faculty of Health Science and Medicine, Gold Coast, Queensland, Australia
| | - David Grosser
- Gold Coast Private Hospital, Southport, Queensland, Australia
- Pindara Private Hospital, Benowa, Queensland, Australia
- Southern Queensland CardioVascular Centre, Gold Coast, Queensland, Australia
| | - Mario Zotti
- Bond University, Faculty of Health Science and Medicine, Gold Coast, Queensland, Australia
- Gold Coast Spine, Gold Coast, Queensland, Australia
- Gold Coast Private Hospital, Southport, Queensland, Australia
- Pindara Private Hospital, Benowa, Queensland, Australia
- Southern Queensland CardioVascular Centre, Gold Coast, Queensland, Australia
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Maciel RRBT, Dos Santos NC, Portella DDA, Alves PGJM, Martinez BP. Effects of physical exercise at the workplace for treatment of low back pain: a systematic review with meta-analysis. Rev Bras Med Trab 2018; 16:225-235. [PMID: 32270086 DOI: 10.5327/z1679443520180133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/01/2018] [Indexed: 11/05/2022] Open
Abstract
Background The prevalence of low back pain is high among the economically active population. Low back pain reduces productivity and causes absenteeism, impaired quality of life and leaves of absence. Several measures were suggested to reduce the occurrence of this occupational condition, among which physical exercise at the workplace stands out. Aim To analyze studies which assessed physical exercise at the workplace for treatment of low back pain. Methods The present study consisted of a systematic review with meta-analysis. An electronic search was conducted on database MEDLINE using keywords "workplace," "low back pain" and "exercise," synonyms and headings located on Health Sciences Descriptors and Medical Subject Headings. We considered all the studies that included physical exercise at the workplace and defined low back pain as outcome. Results We located 499 potential studies and finally included 15 for review. The duration of treatment varied from 3 weeks to 18 months, and the main interventions were strength and stretching exercises and muscle relaxation. Conclusions The meta-analysis showed that physical exercise at the workplace did not reduce the occurrence of low back pain (difference of means=0.62, 95%CI -0.8-2.04, p<0.4). The present systematic review was registered in database PROSPERO, registration number CRD42017071563.
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Affiliation(s)
- Roberto Rodrigues Bandeira Tosta Maciel
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| | - Natasha Cordeiro Dos Santos
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| | - Daniel Deivson Alves Portella
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| | - Priscila Godoy Januário Martins Alves
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| | - Bruno Prata Martinez
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
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Goubert L, Trompetter H. Towards a science and practice of resilience in the face of pain. Eur J Pain 2017; 21:1301-1315. [PMID: 28573783 DOI: 10.1002/ejp.1062] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 12/25/2022]
Abstract
The primary objective of this paper is to discuss how a resilience approach to (chronic) pain may advance our current understanding of (mal)adaptation to pain. Different resilience perspectives are described, and future challenges for research, prevention and treatment of (chronic) pain are discussed. Literature searches were performed in Web of Science and PubMed to identify relevant literature on risk and resilience in the context of pain. Resilience can be best defined as the ability to restore and sustain living a fulfilling life in the presence of pain. The Psychological Flexibility Model, the Broaden-and-Build Theory, and Self-Determination Theory are described as theories that may provide insight into resilience within the context of (chronic) pain. We describe how a resilience paradigm shifts the outcomes to pursue in pain research and intervention and argue the need for including positive outcomes in addition to negative outcomes. Psychological flexibility, positive affect and basic psychological needs satisfaction are described as potentially important resilience mechanisms with the potential to target both sustainability and recovery from pain. A resilience approach to chronic pain may have important implications for the prevention and treatment of chronic pain problems, as it may give specific indications on how to empower patients to continue living a fulfilling life (in the presence of pain). SIGNIFICANCE The resilience approach put forward in this review spotlights sustainability of positive outcomes (e.g. engagement in meaningful activities) in the presence of pain as an outcome to pursue beyond recovery of negative outcomes. We illuminate the evidence-base and practical application of promising resilience mechanisms (positive emotions, psychological flexibility, needs satisfaction). For this article, a commentary is available at the Wiley Online Library.
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Affiliation(s)
- L Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - H Trompetter
- Department of Psychology, Health and Technology, Center for eHealth and Wellbeing Research, University of Twente, Enschede, The Netherlands
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Suman A, Bostick GP, Schaafsma FG, Anema JR, Gross DP. Associations between measures of socio-economic status, beliefs about back pain, and exposure to a mass media campaign to improve back beliefs. BMC Public Health 2017; 17:504. [PMID: 28545420 PMCID: PMC5445411 DOI: 10.1186/s12889-017-4387-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/08/2017] [Indexed: 11/23/2022] Open
Abstract
Background Low back pain (LBP) is one of the most common and costly healthcare problems worldwide. Disability from LBP is associated with maladaptive beliefs about the condition, and such beliefs can be influenced by public health interventions. While socioeconomic status (SES) has been identified as an important factor in health literacy and inequalities, not much is known about the association between SES and beliefs about LBP. Therefore, this study examined the relationship between measures of SES and the belief that one should stay active through LBP in a representative sample of the general population in Alberta, Canada. We also examined the association between measures of SES and self-reported exposure to a LBP mass media health education campaign. Methods Population-based surveys from 2010 through 2014 were conducted among 9572 randomly selected Alberta residents aged 18–65 years. Several methods for measuring SES, including first language, education, employment status, occupation, and annual household income, were included in multivariable logistic regression modeling to test associations between measures of SES and outcomes. Results Univariable analysis showed that age, language, education, employment, marital status, and annual household income were significantly associated with the belief that one should stay active through LBP. In multivariable analysis, income was the variable most strongly correlated with this belief (odds ratios ranged from 1.04 to 1.62 for the highest income category, p = 0.005). Univariable analysis for exposure to the campaign showed age, language, education, employment, and occupation to be significantly associated with self-reported exposure, while only education (p = 0.01) and age (p = 0.001) remained significant in multivariable analysis. Conclusions Individuals with higher annual income appear more likely to believe that one should stay active during an episode of LBP. Additionally, targeted information campaigns are recalled more by low SES groups and may thus assist in reducing health disparities. More research is needed to fully understand the association between socioeconomic factors and LBP and to target campaigns accordingly. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4387-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arnela Suman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Centre, PO Box 7067, 1007, MB, Amsterdam, The Netherlands
| | - Geoffrey P Bostick
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, T6G 2G4, Canada
| | - Frederieke G Schaafsma
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Centre, PO Box 7067, 1007, MB, 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, Amsterdam Public Health research institute, VU University Medical Centre, PO Box 7067, 1007, MB, Amsterdam, The Netherlands.,Research Centre for Insurance Medicine, Collaboration between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, T6G 2G4, Canada.
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Batista AADS, Henschke N, Oliveira VC. Prevalence of low back pain in different educational levels: a systematic review. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.s01.ar04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Non-specific low back pain (LBP) can be understood through the interaction of biopsychosocial factors such as education. Unfortunately, it remains unclear whether education can be considered an important risk and prognostic factor for the occurrence of LBP. Objective: To investigate the association between education and LBP. Methods: The following databases were searched: MEDLINE, EMBASE, Cochrane, AMED and PsyINFO. Results: Thirteen studies were included in the review. The Prevalence Critical Appraisal Instrument (PCAI) was used to assess risk of bias. Methodological quality scores ranged from 7 to 10 on a scale of 0-10. There was a 23% (95% CI, 13-37) prevalence of LBP (10,582 out of a total of 99,457 cases) in the general sample at the time of assessment. The meta-analysis of studies on the prevalence of LBP in people with low, medium or high educational level found the following results, respectively: 24% (95% CI, 12-43), 27% (95% CI, 9-56), and 18% (95% CI, 5-50). The meta-regression identified heterogeneity among the studies included in the review. This can be explained by educational differences (p < 0.05). Conclusion: Occurrence of LBP varies according to educational level. Individuals with higher educational levels are less often affected by LBP than individuals with medium or low educational levels.
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Abdel Shaheed C, Maher CG, Mak W, Williams KA, McLachlan AJ. Knowledge and satisfaction of pharmacists attending an educational workshop on evidence-based management of low back pain. Aust J Prim Health 2015; 21:126-31. [PMID: 24802263 DOI: 10.1071/py14020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 03/22/2014] [Indexed: 11/23/2022]
Abstract
Pharmacists are well positioned to provide quality care to people with low back pain (LBP). Education and training can equip pharmacists with the knowledge to optimally manage LBP in primary care. The aim of this study was to investigate the knowledge and satisfaction of pharmacists who attended a 2-h educational workshop on the evidence-based management of LBP. Case-based learning, underpinned by key adult learning principles, was one teaching method used to deliver important educational messages. Knowledge was assessed using a questionnaire consisting of multiple-choice, true/false questions and a written vignette based on a real-life clinical case scenario. Written feedback from pharmacists was used to gauge the success and limitations of the intervention. One hundred and ninety-three pharmacists completed the in-house assessment. Pharmacists demonstrated an accurate understanding of evidence-based pharmacological management of LBP, with all identifying paracetamol as the first-line drug choice for non-specific LBP. Ninety-nine per cent of pharmacists identified the symptoms presented in the vignette as a syndrome representing a significant clinical red flag requiring urgent referral. This educational intervention has delivered key messages on LBP management to pharmacists. There is a continued need for educational interventions addressing common conditions.
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Munigangaiah S, Basavaraju N, Jadaan DY, Devitt AT, McCabe JP. Do “Myths” of low back pain exist among Irish population? A cross-sectional study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 26:41-6. [DOI: 10.1007/s00590-015-1698-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022]
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Franz EW, Bentley JN, Yee PPS, Chang KWC, Kendall-Thomas J, Park P, Yang LJS. Patient misconceptions concerning lumbar spondylosis diagnosis and treatment. J Neurosurg Spine 2015; 22:496-502. [DOI: 10.3171/2014.10.spine14537] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Patient outcome measures are becoming increasingly important in the evaluation of health care quality and physician performance. Of the many novel measures currently being explored, patient satisfaction and other subjective measures of patient experience are among the most heavily weighted. However, these subjective measures are strongly influenced by a number of factors, including patient demographics, level of understanding of the disorder and its treatment, and patient expectations. In the present study, patients referred to a neurosurgery clinic for degenerative spinal disorders were surveyed to determine their understanding of lumbar spondylosis diagnosis and treatment.
METHODS
A multiple-choice, 6-question survey was distributed to all patients referred to a general neurosurgical spine clinic at a tertiary care center over a period of 11 months as a quality improvement initiative to assist the provider with individualized patient counseling. The survey consisted of questions designed to assess patient understanding of the role of radiological imaging in the diagnosis and treatment of low-back and leg pain, and patient perception of the indications for surgical compared with conservative management. Demographic data were also collected.
RESULTS
A total of 121 surveys were included in the analysis. More than 50% of the patients indicated that they would undergo spine surgery based on abnormalities found on MRI, even without symptoms; more than 40% of patients indicated the same for plain radiographs. Similarly, a large proportion of patients (33%) believed that back surgery was more effective than physical therapy in the treatment of back pain without leg pain. Nearly one-fifth of the survey group (17%) also believed that back injections were riskier than back surgery. There were no significant differences in survey responses among patients with a previous history of spine surgery compared with those without previous spine surgery.
CONCLUSIONS
These results show that a surprisingly high percentage of patients have misconceptions regarding the diagnosis and treatment of lumbar spondylosis, and that these misconceptions persist in patients with a history of spine surgery. Specifically, patients overemphasize the value of radiological studies and have mixed perceptions of the relative risk and effectiveness of surgical intervention compared with more conservative management. These misconceptions have the potential to alter patient expectations and decrease satisfaction, which could negatively impact patient outcomes and subjective valuations of physician performance. While these results are preliminary, they highlight a need for improved communication and patient education during surgical consultation for lumbar spondylosis.
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Affiliation(s)
| | - J. Nicole Bentley
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Patricia P. S. Yee
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Kate W. C. Chang
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | - Paul Park
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Lynda J. S. Yang
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Back pain beliefs are related to the impact of low back pain in baby boomers in the Busselton Healthy Aging Study. Phys Ther 2015; 95:180-9. [PMID: 25256742 DOI: 10.2522/ptj.20140064] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Back pain beliefs (BPBs) are an important modifiable factor related to disability associated with low back pain (LBP). Back pain beliefs have not been characterized in baby boomers, a group at risk for decreased activity levels and reduced productivity. OBJECTIVE The aims of this study were: (1) to identify factors related to BPBs and (2) to evaluate the association between LBP disability and beliefs. DESIGN A cross-sectional survey of community-dwelling baby boomers (born 1946-1964) was conducted. METHODS Nine hundred fifty-eight baby boomers (mean age=56.2 years) participating in the Busselton Healthy Aging Study provided their history of LBP, BPBs, LBP behaviors related to care seeking (taking medication, seeking professional help) and activity modification (missing work, interference with normal activities, interference with recreational activities), LBP-related disability, and additional covariates with known associations with BPBs. Regression analyses were used to: (1) identify factors associated with more positive beliefs and (2) test the association between more positive BPBs and lower LBP disability, independent of other correlates of BPBs. RESULTS More positive BPBs were associated with younger age, better mental well-being, and higher income, whereas more negative BPBs were associated with receiving sickness or disability benefits and the experience of LBP in the previous month. In participants who reported experiencing LBP within the previous month, more positive BPBs were associated with lower disability scale scores and a decreased probability of interference with usual activities, independent of pain intensity, age, mental well-being, income, and employment status. LIMITATIONS Cross-sectional analysis limits assessment of causality. CONCLUSIONS Poorer BPBs were associated with greater disability. Characterization of the relationships between BPBs and LBP-associated behaviors and disability in baby boomers can assist in developing interventions to improve activity participation and productivity, potentially reducing the burden of LBP in this age group.
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Henry SM, Van Dillen L, Ouellette-Morton RH, Hitt JR, Lomond KV, DeSarno MJ, Bunn JY. Outcomes are not different for patient-matched versus nonmatched treatment in subjects with chronic recurrent low back pain: a randomized clinical trial. Spine J 2014; 14:2799-810. [PMID: 24662210 PMCID: PMC4171247 DOI: 10.1016/j.spinee.2014.03.024] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 01/20/2014] [Accepted: 03/16/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Classification schemas for low back pain (LBP), such as the Treatment-Based Classification and the Movement System Impairment, use common clinical features to subgroup patients with LBP and are purported to improve treatment outcomes. PURPOSE To assess if providing matched treatments based on patient-specific clinical features led to superior treatment outcomes compared with an unmatched treatment for subjects with chronic recurrent LBP. STUDY DESIGN This study is a randomized controlled trial. PATIENT SAMPLE Subjects (n=124) with LBP (≥12 months) with or without recurrences underwent a standardized clinical examination to group them into one of two strata: ineligible or eligible for stabilization exercises based on the Treatment-Based Classification schema. Subjects underwent additional clinical tests to assign them to one of the five possible Movement System Impairment categories. OUTCOME MEASURES Questionnaires were collected electronically at Week 0 (before treatment), Week 7 (after the 6-week 1-hour treatment sessions), and 12 months. Using the Oswestry disability index (0-100) and the Numeric Pain Rating Scale (0-10), the primary analysis was performed using the intention-to-treat principle. Secondary outcomes included fear-avoidance beliefs and psychosocial work-related and general health status. METHODS After subjects were categorized based on their particular clinical features using both the Treatment-Based Classification and Movement System Impairment schemas, they were randomized into one of two treatments using a 3:1 ratio for matched or unmatched treatments. The treatments were trunk stabilization exercise or Movement System Impairment-directed exercises. RESULTS Of the patients allocated to treatment for this study, 76 received a matched treatment and 25 received an unmatched treatment. After treatment, both groups showed a statistically significant improvement in the primary outcome measures and almost all the secondary measures; however, the matched treatment group did not demonstrate superior outcomes at Week 7 or 12 months, except on one of the secondary measures (Graded Chronic Pain Scale [Disability Scale]) (p=.01). CONCLUSIONS Providing a matched treatment based on either the Treatment-Based Classification or the Movement System Impairment classification schema did not improve treatment outcomes compared with an unmatched treatment for patients with chronic LBP, except on one secondary disability measure.
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Affiliation(s)
- Sharon M. Henry
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont
| | - Linda Van Dillen
- Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Juvena R. Hitt
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont
| | - Karen V. Lomond
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont
| | - Michael J. DeSarno
- Department of Biostatistics, College of Medicine, University of Vermont, Burlington, Vermont
| | - Janice Y. Bunn
- Department of Biostatistics, College of Medicine, University of Vermont, Burlington, Vermont
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Guillaume O, Naqvi SM, Lennon K, Buckley CT. Enhancing cell migration in shape-memory alginate–collagen composite scaffolds: In vitro and ex vivo assessment for intervertebral disc repair. J Biomater Appl 2014; 29:1230-46. [DOI: 10.1177/0885328214557905] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lower lumbar disc disorders pose a significant problem in an aging society with substantial socioeconomic consequences. Both inner tissue (nucleus pulposus) and outer tissue (annulus fibrosus) of the intervertebral disc are affected by such debilitating disorders and can lead to disc herniation and lower back pain. In this study, we developed an alginate–collagen composite porous scaffold with shape-memory properties to fill defects occurring in annulus fibrosus tissue of degenerated intervertebral discs, which has the potential to be administered using minimal invasive surgery. In the first part of this work, we assessed how collagen incorporation on preformed alginate scaffolds influences the physical properties of the final composite scaffold. We also evaluated the ability of annulus fibrosus cells to attach, migrate, and proliferate on the composite alginate–collagen scaffolds compared to control scaffolds (alginate only). In vitro experiments, performed in intervertebral disc-like microenvironmental conditions (low glucose and low oxygen concentrations), revealed that for alginate only scaffolds, annulus fibrosus cells agglomerated in clusters with limited infiltration and migration capacity. In comparison, for alginate–collagen scaffolds, annulus fibrosus cells readily attached and colonized constructs, while preserving their typical fibroblastic-like cell morphology with spreading behavior and intense cytoskeleton expression. In a second part of this study, we investigated the effects of alginate–collagen scaffold when seeded with bone marrow derived mesenchymal stem cells. In vitro, we observed that alginate–collagen porous scaffolds supported cell proliferation and extracellular matrix deposition (collagen type I), with secretion amplified by the local release of transforming growth factor-β3. In addition, when cultured in ex vivo organ defect model, alginate–collagen scaffolds maintained viability of transplanted mesenchymal stem cells for up to 5 weeks. Taken together, these findings illustrate the advantages of incorporating collagen as a means to enhance cell migration and proliferation in porous scaffolds which could be used to augment tissue repair strategies.
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Affiliation(s)
- Olivier Guillaume
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Department of Mechanical Engineering, School of Engineering, Trinity College Dublin, Ireland
| | - Syeda Masooma Naqvi
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Department of Mechanical Engineering, School of Engineering, Trinity College Dublin, Ireland
| | - Kerri Lennon
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Department of Mechanical Engineering, School of Engineering, Trinity College Dublin, Ireland
| | - Conor Timothy Buckley
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Department of Mechanical Engineering, School of Engineering, Trinity College Dublin, Ireland
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Jordá Llona M, Pérez Bocanegra E, García-Mifsud M, Jimeno Bernad R, Ortiz Hernández R, Castells Ayuso P. Back school: A simple way to improve pain and postural behaviour. An Pediatr (Barc) 2014. [DOI: 10.1016/j.anpede.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Yue YS, Wang XD, Xie B, Li ZH, Chen BL, Wang XQ, Zhu Y. Sling exercise for chronic low back pain: a systematic review and meta-analysis. PLoS One 2014; 9:e99307. [PMID: 24919119 PMCID: PMC4053356 DOI: 10.1371/journal.pone.0099307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/13/2014] [Indexed: 12/19/2022] Open
Abstract
Background Trials on sling exercise (SE), commonly performed to manage chronic low back pain (LBP), yield conflicting results. This study aimed to review the effects of SE on chronic LBP. Methods The randomized controlled trials comparing SE with other treatments or no treatment, published up to August 2013, were identified by electronic searches. Primary outcomes were pain, function, and return to work. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated, using a random-effects model. Results Risk of bias was rated as high in 9 included trials, where some important quality components such as blinding were absent and sample sizes were generally small. We found no clinically relevant differences in pain or function between SE and other forms of exercise, traditional Chinese medical therapy, or in addition to acupuncture. Based on two trials, SE was more effective than thermomagnetic therapy at reducing pain (short-term: WMD –13.90, 95% CI –22.19 to –5.62; long-term: WMD –26.20, 95% CI –31.32 to –21.08) and improving function (short-term: WMD –10.54, 95% CI –14.32 to –6.75; long-term: WMD –25.75, 95% CI –30.79 to –20.71). In one trial we found statistically significant differences between SE and physical agents combined with drug therapy (meloxicam combined with eperisone hydrochloride) but of borderline clinical relevance for pain (short-term: WMD –15.00, 95% CI –19.64 to −10.36) and function (short-term: WMD −10.00; 95% CI −13.70 to −6.30). There was substantial heterogeneity among the two trials comparing SE and thermomagnetic therapy; both these trials and the trial comparing SE with physical agents combined with drug therapy had serious methodological limitations. Interpretation Based on limited evidence from 2 trials, SE was more effective for LBP than thermomagnetic therapy. Clinically relevant differences in effects between SE and other forms of exercise, physical agents combined with drug therapy, traditional Chinese medical therapy, or in addition to acupuncture could not be found. More high-quality randomized trials on the topic are warranted.
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Affiliation(s)
- Yu-Shan Yue
- Second School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Xu-Dong Wang
- Institute of Literature in Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Bin Xie
- First School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Zhong-Han Li
- Applied Health Science Department, University of Waterloo, Waterloo, Ontario, Canada
| | - Bing-Lin Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- * E-mail: (X-QW); (YZ)
| | - Yi Zhu
- Second School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- * E-mail: (X-QW); (YZ)
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Severity of pediatric pain in relation to school-related functioning and teacher support: An epidemiological study among school-aged children and adolescents. Pain 2014; 155:1118-1127. [DOI: 10.1016/j.pain.2014.02.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/11/2014] [Accepted: 02/26/2014] [Indexed: 11/17/2022]
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van Wilgen P, Beetsma A, Neels H, Roussel N, Nijs J. Physical therapists should integrate illness perceptions in their assessment in patients with chronic musculoskeletal pain; a qualitative analysis. ACTA ACUST UNITED AC 2014; 19:229-34. [DOI: 10.1016/j.math.2013.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 11/08/2013] [Accepted: 11/16/2013] [Indexed: 12/26/2022]
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Darlow B, Perry M, Mathieson F, Stanley J, Melloh M, Marsh R, Baxter GD, Dowell A. The development and exploratory analysis of the Back Pain Attitudes Questionnaire (Back-PAQ). BMJ Open 2014; 4:e005251. [PMID: 24860003 PMCID: PMC4039861 DOI: 10.1136/bmjopen-2014-005251] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To develop an instrument to assess attitudes and underlying beliefs about back pain, and subsequently investigate its internal consistency and underlying structures. DESIGN The instrument was developed by a multidisciplinary team of clinicians and researchers based on analysis of qualitative interviews with people experiencing acute and chronic back pain. Exploratory analysis was conducted using data from a population-based cross-sectional survey. SETTING Qualitative interviews with community-based participants and subsequent postal survey. PARTICIPANTS Instrument development informed by interviews with 12 participants with acute back pain and 11 participants with chronic back pain. Data for exploratory analysis collected from New Zealand residents and citizens aged 18 years and above. 1000 participants were randomly selected from the New Zealand Electoral Roll. 602 valid responses were received. MEASURES The 34-item Back Pain Attitudes Questionnaire (Back-PAQ) was developed. Internal consistency was evaluated by the Cronbach α coefficient. Exploratory analysis investigated the structure of the data using Principal Component Analysis. RESULTS The 34-item long form of the scale had acceptable internal consistency (α=0.70; 95% CI 0.66 to 0.73). Exploratory analysis identified five two-item principal components which accounted for 74% of the variance in the reduced data set: 'vulnerability of the back'; 'relationship between back pain and injury'; 'activity participation while experiencing back pain'; 'prognosis of back pain' and 'psychological influences on recovery'. Internal consistency was acceptable for the reduced 10-item scale (α=0.61; 95% CI 0.56 to 0.66) and the identified components (α between 0.50 and 0.78). CONCLUSIONS The 34-item long form of the scale may be appropriate for use in future cross-sectional studies. The 10-item short form may be appropriate for use as a screening tool, or an outcome assessment instrument. Further testing of the 10-item Back-PAQ's construct validity, reliability, responsiveness to change and predictive ability needs to be conducted.
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Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Meredith Perry
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Fiona Mathieson
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - James Stanley
- Biostatistical Group, University of Otago, Wellington, New Zealand
| | - Markus Melloh
- Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Reginald Marsh
- Gillies McIndoe Research Institute, Newtown, Wellington South, New Zealand
| | - G David Baxter
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Darlow B, Perry M, Stanley J, Mathieson F, Melloh M, Baxter GD, Dowell A. Cross-sectional survey of attitudes and beliefs about back pain in New Zealand. BMJ Open 2014; 4:e004725. [PMID: 24859999 PMCID: PMC4039787 DOI: 10.1136/bmjopen-2013-004725] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To explore the prevalence of attitudes and beliefs about back pain in New Zealand and compare certain beliefs based on back pain history or health professional exposure. DESIGN Population-based cross-sectional survey. SETTING Postal survey. PARTICIPANTS New Zealand residents and citizens aged 18 years and above. 1000 participants were randomly selected from the New Zealand Electoral Roll. Participants listed on the Electoral Roll with an overseas postal address were excluded. 602 valid responses were received. MEASURES Attitudes and beliefs about back pain were measured with the Back Pain Attitudes Questionnaire (Back-PAQ). The interaction between attitudes and beliefs and (1) back pain experience and (2) health professional exposure was investigated. RESULTS The lifetime prevalence of back pain was reported as 87% (95% CI 84% to 90%), and the point prevalence as 27% (95% CI 24% to 31%). Negative views about the back and back pain were prevalent, in particular the need to protect the back to prevent injury. People with current back pain had more negative overall scores, particularly related to back pain prognosis. There was uncertainty about links between pain and injury and appropriate physical activity levels during an episode of back pain. Respondents had more positive views about activity if they had consulted a health professional about back pain. The beliefs of New Zealanders appeared to be broadly similar to those of other Western populations. CONCLUSIONS A large proportion of respondents believed that they needed to protect their back to prevent injury; we theorise that this belief may result in reduced confidence to use the back and contribute to fear avoidance. Uncertainty regarding what is a safe level of activity during an episode of back pain may limit participation. People experiencing back pain may benefit from more targeted information about the positive prognosis. The provision of clear guidance about levels of activity may enable confident participation in an active recovery.
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Affiliation(s)
- Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Meredith Perry
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - James Stanley
- Biostatistical Group, University of Otago, Wellington, New Zealand
| | - Fiona Mathieson
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Markus Melloh
- Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - G David Baxter
- Centre for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C, Burstein R, Buchbinder R. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014; 73:968-74. [PMID: 24665116 DOI: 10.1136/annrheumdis-2013-204428] [Citation(s) in RCA: 1664] [Impact Index Per Article: 166.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the global burden of low back pain (LBP). METHODS LBP was defined as pain in the area on the posterior aspect of the body from the lower margin of the twelfth ribs to the lower glutaeal folds with or without pain referred into one or both lower limbs that lasts for at least one day. Systematic reviews were performed of the prevalence, incidence, remission, duration, and mortality risk of LBP. Four levels of severity were identified for LBP with and without leg pain, each with their own disability weights. The disability weights were applied to prevalence values to derive the overall disability of LBP expressed as years lived with disability (YLDs). As there is no mortality from LBP, YLDs are the same as disability-adjusted life years (DALYs). RESULTS Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, LBP ranked highest in terms of disability (YLDs), and sixth in terms of overall burden (DALYs). The global point prevalence of LBP was 9.4% (95% CI 9.0 to 9.8). DALYs increased from 58.2 million (M) (95% CI 39.9M to 78.1M) in 1990 to 83.0M (95% CI 56.6M to 111.9M) in 2010. Prevalence and burden increased with age. CONCLUSIONS LBP causes more global disability than any other condition. With the ageing population, there is an urgent need for further research to better understand LBP across different settings.
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Affiliation(s)
- Damian Hoy
- University of Queensland, School of Population Health, , Herston, Queensland, Australia
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[Back school: a simple way to improve pain and postural behaviour]. An Pediatr (Barc) 2014; 81:92-8. [PMID: 24380773 DOI: 10.1016/j.anpedi.2013.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 11/06/2013] [Accepted: 11/18/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Non-specific back pain in children and adolescents has a high prevalence. The aim of this study is to show a Juvenile Back School (JBS) programme and its results in our hospital. MATERIAL AND METHOD A total of 139 patients referred to a Juvenile Back School for advice due to of pain, deformity or back asymmetry were included in a prospective observational study. VARIABLES age, gender, pain, correct postures, sports activities, adherence to JBS and appreciation of these parameters by their parents. VARIABLES were measured with a numerical pain scale and with a survey completed in the first session and 3 months after finishing the JBS. RESULTS A total of 119 patients finished the study (78 female and 41 male).The average was 13.97±2.29 years (9-20). Three months after JBS, the median pain intensity was reduced from 3 to 0 (P<.0001). There was an improvement in patient postures from 21% to 83% (P<.0001). Patients did not increase their sport activity after the JBS, although its regular practice was linked with pain improvement after JBS (P<.02).Performing exercises did not lead to a decrease in pain. There was a poor correlation between parents and children in the evaluation of post-JBS pain. CONCLUSION A back school programme could probably contribute to reduce non-specific back pain and improve postural behaviour in young people.
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Interventions available over the counter and advice for acute low back pain: systematic review and meta-analysis. THE JOURNAL OF PAIN 2013; 15:2-15. [PMID: 24373568 DOI: 10.1016/j.jpain.2013.09.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/20/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED This systematic review evaluated evidence from randomized controlled trials investigating interventions available over the counter and advice that could be provided to people with acute low back pain. Searches were conducted on MEDLINE, Embase, Cochrane Database of Systematic Reviews, AMED, CENTRAL, and PsycINFO for eligible randomized controlled trials. The primary outcome measure was pain. Eligible controls included placebo, no treatment, or usual care. Two reviewers extracted data and rated study quality. A random effects model was used to pool trial effects with the overall strength of evidence described using the GRADE criteria. Thirteen randomized controlled trials (2,847 participants) evaluating advice, bed rest, simple analgesics (paracetamol, nonsteroidal anti-inflammatory drugs), heat application, and a topical rubefacient were included. There was low-quality evidence that bed rest is ineffective and very-low-quality evidence that advice is ineffective in the short, intermediate, and long terms. There was very-low-quality evidence that nonsteroidal anti-inflammatory drugs (ibuprofen and diclofenac "when required" dosing) provide an immediate analgesic effect (mean differences -10.9 [95% confidence interval = -17.6 to -4.2] and -11.3 [95% confidence interval = -17.8 to -4.9], respectively). There is very-low-quality evidence that heat wrap and a capsicum-based rubefacient provide an immediate analgesic effect (mean differences -13.5 [95% confidence interval = -21.3 to -5.7] and 17.5, P < .001, respectively), but there was no information on longer-term outcomes. PERSPECTIVE There is limited evidence that nonsteroidal anti-inflammatory drugs, heat wrap, and rubefacients provide immediate pain relief for acute back pain and that bed rest and advice are both ineffective. Future research is needed to provide evidence to support rational use of over-the-counter remedies and advice for people with acute low back pain.
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Buchbinder R, Blyth FM, March LM, Brooks P, Woolf AD, Hoy DG. Placing the global burden of low back pain in context. Best Pract Res Clin Rheumatol 2013; 27:575-89. [PMID: 24315140 DOI: 10.1016/j.berh.2013.10.007] [Citation(s) in RCA: 218] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The latest Global Burden of Disease Study, published at the end of 2012, has highlighted the enormous global burden of low back pain. In contrast to the previous study, when it was ranked 105 out of 136 conditions, low back pain is now the leading cause of disability globally, ahead of 290 other conditions. It was estimated to be responsible for 58.2 million years lived with disability in 1990, increasing to 83 million in 2010. This chapter illustrates the ways that the Global Burden of Disease data can be displayed using the data visualisation tools specifically designed for this purpose. It also considers how best to increase the precision of future global burden of low back pain estimates by identifying limitations in the available data and priorities for further research. Finally, it discusses what should be done at a policy level to militate against the rising burden of this condition.
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Affiliation(s)
- Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Hospital, Suite 41, 183 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, VIC, Australia.
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De Ruddere L, Goubert L, Stevens M, de C. Williams AC, Crombez G. Discounting pain in the absence of medical evidence is explained by negative evaluation of the patient. Pain 2013; 154:669-676. [DOI: 10.1016/j.pain.2012.12.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 10/16/2012] [Accepted: 12/11/2012] [Indexed: 01/22/2023]
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Woolf AD, Erwin J, March L. The need to address the burden of musculoskeletal conditions. Best Pract Res Clin Rheumatol 2013; 26:183-224. [PMID: 22794094 DOI: 10.1016/j.berh.2012.03.005] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 02/12/2012] [Indexed: 10/28/2022]
Abstract
Musculoskeletal conditions are common in men and women of all ages across all socio-demographic strata of society. They are the most common cause of severe long-term pain and physical disability and affect hundreds of millions of people around the world. They impact on all aspects of life through pain and by limiting activities of daily living typically by affecting dexterity and mobility. They affect one in four adults across Europe [1]. Musculoskeletal conditions have an enormous economic impact on society through both direct health expenditure related to treating the sequelae of the conditions and indirectly through loss of productivity. The prevalence of many of these conditions increases markedly with age, and many are affected by lifestyle factors, such as obesity and lack of physical activity. The burden of these conditions is therefore predicted to increase, in particular in developing countries. The impact on individuals and society of the major musculoskeletal conditions is reviewed and effective prevention, treatment and rehabilitation considered. The need to recognise musculoskeletal conditions as a global public health priority is discussed.
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Affiliation(s)
- Anthony D Woolf
- Department of Rheumatology, Royal Cornwall Hospital, Truro, UK.
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De Ruddere L, Goubert L, Vervoort T, Prkachin KM, Crombez G. We Discount the Pain of Others When Pain Has No Medical Explanation. THE JOURNAL OF PAIN 2012; 13:1198-205. [DOI: 10.1016/j.jpain.2012.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 09/10/2012] [Accepted: 09/15/2012] [Indexed: 11/17/2022]
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