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Barrett DR, Nielsen LM, Rhon DI, Young JL. What are patients' perspectives on the value of physical therapy? A prospective cohort study. Musculoskeletal Care 2024; 22:e1871. [PMID: 38393306 DOI: 10.1002/msc.1871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To assess and identify patients' perceptions about the overall value of physical therapy services for musculoskeletal conditions and how these values were associated with their outcomes. METHODS The association between the perceived value of physical therapy (as a score) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function at 6-weeks was assessed in a prospective cohort. Generalised linear models were used to identify relationships between the value of physical therapy score and PROMIS outcomes. Kendall's tau was used to identify correlations between responses and outcomes. RESULTS A total of 133 participants met the final inclusion criteria. The majority of participants were female (63.9%) with a mean age of 55.53 (SD 15.36) years. A majority of participants (63.9%) reported a previous positive personal experience with physical therapy. There was no significant relationship between perceived value of physical therapy and pain interference (β -0.32, p = 0.07, 95% CI-0.67, 0.03) or physical function (β 0.19, p = 0.29, 95% CI-0.16, 0.54). Stronger beliefs in agreement with the value of non-invasive treatment were significant, but weakly correlated with lower pain interference (r = -0.18, p = 0.048) and higher physical function scores (r = 0.22, p = 0.03). CONCLUSIONS Participants had an overall positive perception of the value of physical therapy prior to initiating physical therapy, but this perception was not associated with 6-week pain and function outcomes. A better understanding of the driving factors encouraging patients to seek physical therapy services is needed to provide value-based care.
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Affiliation(s)
- Dustin R Barrett
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Therapy, Emory and Henry College, Marion, Virginia, USA
| | | | - Daniel I Rhon
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Medicine & Rehabilitation, F. Edward Hébert School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Jodi L Young
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
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Muñoz Laguna J, Puhan MA, Rodríguez Artalejo F, De Pauw R, Wyper GMA, Devleesschauwer B, Santos JV, Hincapié CA. Certainty of the Global Burden of Disease 2019 Modelled Prevalence Estimates for Musculoskeletal Conditions: A Meta-Epidemiological Study. Int J Public Health 2023; 68:1605763. [PMID: 37325175 PMCID: PMC10266422 DOI: 10.3389/ijph.2023.1605763] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/27/2023] [Indexed: 06/17/2023] Open
Abstract
Objectives: To describe and assess the risk of bias of the primary input studies that underpinned the Global Burden of Disease Study (GBD) 2019 modelled prevalence estimates of low back pain (LBP), neck pain (NP), and knee osteoarthritis (OA), from Australia, Brazil, Canada, Spain, and Switzerland. To evaluate the certainty of the GBD modelled prevalence evidence. Methods: Primary studies were identified using the GBD Data Input Sources Tool and their risk of bias was assessed using a validated tool. We rated the certainty of modelled prevalence estimates based on the GRADE Guidelines 30-the GRADE approach for modelled evidence. Results: Seventy-two primary studies (LBP: 67, NP: 2, knee OA: 3) underpinned the GBD estimates. Most studies had limited representativeness of their study populations, used suboptimal case definitions and applied assessment instruments with unknown psychometric properties. The certainty of modelled prevalence estimates was low, mainly due to risk of bias and indirectness. Conclusion: Beyond the risk of bias of primary input studies for LBP, NP, and knee OA in GBD 2019, the certainty of country-specific modelled prevalence estimates still have room for improvement.
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Affiliation(s)
- Javier Muñoz Laguna
- Department of Preventive Medicine, Public Health and Microbiology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Fernando Rodríguez Artalejo
- Department of Preventive Medicine, Public Health and Microbiology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Grant M. A. Wyper
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, United Kingdom
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - João V. Santos
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS—Centre for Health Technology and Services Research, Porto, Portugal
- Public Health Unit, ACES Grande Porto V – Porto Ocidental, ARS Norte, Porto, Portugal
| | - Cesar A. Hincapié
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
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Saiklang P, Puntumetakul R, Selfe J, Yeowell G. An Evaluation of an Innovative Exercise to Relieve Chronic Low Back Pain in Sedentary Workers. HUMAN FACTORS 2022; 64:820-834. [PMID: 33111563 DOI: 10.1177/0018720820966082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The purpose of the study was to examine the effectiveness of a novel supported dynamic lumbar extension with the abdominal drawing-in maneuver (ADIM) technique on stature change, deep abdominal muscle activity, trunk muscle fatigue, and pain intensity during prolonged sitting in chronic low back pain (CLBP) participants. BACKGROUND Prolonged sitting can cause trunk muscle fatigue from continuous contraction of deep trunk muscles in seated postures. Deficiency of activity of deep muscles can reduce muscular support of the spine, causing stress on spinal structures, which could result in pain. METHOD Thirty participants with CLBP were randomly allocated: (a) control-sitting without exercise, and (b) intervention-supported dynamic lumbar extension with the ADIM technique. RESULTS Compared to the intervention condition, the control condition demonstrated significantly greater deterioration in stature change, increased levels of deep trunk muscle fatigue, and an increase in pain during prolonged sitting. CONCLUSION The supported dynamic lumbar extension with the ADIM technique appears to provide a protective effect on detrimental stature change and deep trunk muscle fatigue. In addition, it prevented an increase in pain intensity during prolonged sitting in people with CLBP. APPLICATION Sedentary behavior harms health, particularly affecting the lower back. Clinicians can use the intervention to induce dynamic lumbar movement, and this exercise can maintain deep trunk muscle activity during prolonged sitting, thereby helping to prevent low back pain (LBP) problems.
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Neilson BD, Shepherd MH, Dickerson C, Chaconas EJ, Young JL, Rhon DI. Relationship Between Attitudes and Beliefs About Sleep, Sleep Disturbance, and Pain Interference in Patients With Spinal Pain. Clin J Pain 2022; 38:541-549. [PMID: 35642567 DOI: 10.1097/ajp.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Sleep impairments are a strong predictor of pain, making sleep a potential interest when treating patients with spine pain. Typical beliefs about the importance of sleep in patients seeking care for spinal pain are unknown. The purpose of this study was to describe the beliefs and attitudes about sleep in patients seeking care for spinal pain and to examine the relationships between dysfunctional beliefs and attitudes about sleep (DBAS), disordered sleep, and pain interference. MATERIALS AND METHODS This cross-sectional study included patients presenting to physical therapy with spine pain. Participants completed questionnaires including demographics, medical history, pain interference (pain, enjoyment, and general activity), DBAS-16, and sleep-related impairment (Patient-Reported Outcome Measurement Information System). Correlations were calculated between DBAS-16 scores and measures of sleep quality/quantity, and a generalized linear model was used to investigate the predictive ability of DBAS-16 scores on pain interference. RESULTS The mean DBAS-16 score was 4.22 (SD=2.03), with 52.5% of participants having DBAS. There was a strong relationship between DBAS-16 and Patient-Reported Outcome Measurement Information System ( rs =0.7; P <0.001). For every point higher score on the DBAS-16, pain interference scores increased by approximately half a point (B=0.46; 95% CI 0.33, 0.59, 1.80; P <0.001). DISCUSSION These results highlight a strong relationship between beliefs and attitudes about sleep and measures of sleep quality/quantity and a linear association with pain interference scores. These findings provide a rationale for targeting beliefs and attitudes about sleep when managing pain-related symptoms in patients seeking care for spine pain.
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Affiliation(s)
- Brett D Neilson
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI
- Doctor of Physical Therapy Program, Hawai'i Pacific University, Honolulu, HI
| | - Mark H Shepherd
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI
| | - Chris Dickerson
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI
| | - Eric J Chaconas
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI
| | - Jodi L Young
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI
- Department of Rehab Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
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Kahere M, Hlongwa M, Ginindza TG. A Scoping Review on the Epidemiology of Chronic Low Back Pain among Adults in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052964. [PMID: 35270657 PMCID: PMC8910337 DOI: 10.3390/ijerph19052964] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The global burden of chronic low back pain (CLBP) is a major concern in public health. Several CLBP epidemiological studies have been conducted in high-income-countries (HICs) with little known in low-and-middle-income-countries (LMICs) due to other competing priorities of communicable diseases. The extrapolation of results of studies from HICs for use in LMICs is difficult due to differences in social norms, healthcare systems, and legislations, yet there is urgent need to address this growing burden. It is against this backdrop that we conducted this review to map the current evidence on the distribution of CLBP in Sub-Saharan Africa (SSA). METHODS A comprehensive literature search was conducted from the following databases: PubMed, Google Scholar, Science Direct databases, World Health Organizations library databases, EMBASE, EBSCOhost by searching the following databases within the platform; academic search complete, CINAHL with full text, health sources: nursing/academic and MEDLINE. The title, abstract and the full text screening phases were performed by two independent reviewers with the third reviewer employed to adjudicate discrepancies. The reference list of all included articles was also searched for eligible articles. This scoping review was reported in accordance with the PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation, as well as guided by Arksey and O'Malley's scoping review framework. A thematic content analysis was used to give a narrative account of the review. RESULTS The electronic search strategy retrieved 21,189 articles. Title/abstract and full text screening only identified 11 articles, which were included in this review. The prevalence of CLBP among the general population ranged from 18.1% to 28.2% and from 22.2% to 59.1% among LBP patients. The prevalence of occupation based CLBP ranged from 30.1% to 55.5%. Identified risk factors for CLBP are multifactorial and included biomechanical, psychological, socioeconomic and lifestyle factors, with psychosocial factors playing a significant role. Hypertension, diabetes mellitus, peptic ulcer disease were the most common comorbidities identified. CLBP disability was significantly associated with psychosocial factors. The management of CLBP in primary care follows the traditional biomedical paradigm and primarily involves pain medication and inconsistent with guidelines. CONCLUSIONS There are limited epidemiological data on CLBP in SSA, however, this study concluded that the prevalence and risk factors of CLBP in SSA are comparable to reports in HICs. Considering the projected increase in the burden of CLBP in LMICs extensive research effort is needed to close this knowledge gap.
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Affiliation(s)
- Morris Kahere
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (M.H.); (T.G.G.)
- Correspondence: ; Tel.: +27-836153446
| | - Mbuzeleni Hlongwa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (M.H.); (T.G.G.)
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (M.H.); (T.G.G.)
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Wong CK, Mak RY, Kwok TS, Tsang JS, Leung MY, Funabashi M, Macedo LG, Dennett L, Wong AY. Prevalence, Incidence, and Factors Associated With Non-Specific Chronic Low Back Pain in Community-Dwelling Older Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2021; 23:509-534. [PMID: 34450274 DOI: 10.1016/j.jpain.2021.07.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/10/2021] [Accepted: 07/27/2021] [Indexed: 12/21/2022]
Abstract
Chronic low back pain (CLBP) is common among older adults. This systematic review aimed to summarize: (1) the prevalence and incidence of CLBP in older adults, and (2) demographic, psychological, and clinical factors positively/negatively associated with prevalence/incidence of CLBP among older adults. Four databases were searched to identify relevant publications. Ten studies (31,080 older adults) were included after being screened by 5 independent reviewers using predetermined criteria. The methodological quality of these studies was evaluated by standardized tools. The quality of evidence for all factors were appraised by modified GRADE for cohort studies. Twenty-eight and 1 factors were associated with a higher prevalence and a lower 5-year cumulative incidence of CLBP, respectively. No prognostic factor was identified. There was very limited to limited evidence that females, obesity, anxiety, depression, mental disorders, self-expectation of recovery, self-perceived health status, lifestyle (smoking, daily fluoride consumption), previous falls or lower body injury, retirement/disability due to ill health, family history of body pain, comorbidity (knee osteoarthritis, or chronic obstructive pulmonary disease with/without hypertension), weak abdominal muscles, leg pain, leg pain intensity, widespread pain, pain interference on functioning, use of pain medication, occupational exposure (driving for >20 years, or jobs involving bending/twisting for >10 years), disc space narrowing and severe facet osteoarthritis were significantly related to a higher prevalence of CLBP in older adults. However, very limited evidence suggested that intermediate level of leisure-time physical activity was associated with a lower prevalence of CLBP in older adults. Given the aging population and limited information regarding risk factors for CLBP in older adults, future high-quality prospective studies should identify relevant risk factors to help develop proper preventive and treatment strategies. PERSPECTIVE: Despite the high prevalence of non-specific chronic low back pain among older adults, there is only very limited to limited evidence regarding factors associated with a higher prevalence of chronic low back pain in this population. Given the aging population, high-quality prospective studies are warranted to address this gap.
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Affiliation(s)
- Charles Kw Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Rebecca Yw Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Terence Sy Kwok
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Joshua Sh Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Marco Yc Leung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Martha Funabashi
- Division of Research and Innovation, Canadian Memorial of Chiropractic College, Toronto, Ontario, Canada; Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Luciana G Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Liz Dennett
- Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Arnold Yl Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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Majore-Dusele I, Karkou V, Millere I. The Development of Mindful-Based Dance Movement Therapy Intervention for Chronic Pain: A Pilot Study With Chronic Headache Patients. Front Psychol 2021; 12:587923. [PMID: 33935851 PMCID: PMC8085584 DOI: 10.3389/fpsyg.2021.587923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 03/03/2021] [Indexed: 11/19/2022] Open
Abstract
Chronic pain is of significant global concern. There is growing evidence that body–mind therapies and psychological approaches can contribute toward changing chronic pain perceptions. This is the first model described in the literature that combines a mindfulness-based approach with dance movement therapy and explores the potential psychological and pain-related changes for this client population. In this paper, the results from the pilot study are presented involving patients with chronic headache recruited in an outpatient rehabilitation setting. Methods: In this pilot study, 29 patients (n = 29) with chronic headache were randomized to either the Mindful-Based Dance Movement Therapy (MBDMT) group or the waiting list control group (treatment as usual, TAU). The MBDMT group was offered 10 sessions in a clinical outpatient rehabilitation setting for 5 weeks. Data were collected pre- and post-intervention and 16 weeks after the intervention was finished. The Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire−9 (PHQ-9), Five Facet Mindfulness Questionnaire (FFMQ), and Numeric Rating Scale (NRS) were used as outcome measures. Results: The working model of MBDMT identifies nine therapeutic mechanisms (safe therapeutic environment, mindfulness skills, body awareness, relaxation/releasing, distancing and staying with discomfort, meaning making, self-regulation, acceptance and integration, creative process). Per-protocol analysis reveals statistically significant reduction of pain intensity and depression scores in favor of the MBDMT group, and these improvements were maintained in the follow-up assessment. Conclusions: The results suggest that MBDMT is a feasible and promising therapy approach for chronic pain patients. The pilot study offered sufficient information and preliminary results in the desirable direction to enable the researchers to move to a randomized controlled trial (RCT) stage in order to establish the efficacy of the intervention. Clinical Trial Registration: The study was registered in the www.researchregistry.com, registry (5483).
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Affiliation(s)
- Indra Majore-Dusele
- Department of Health Psychology and Pedagogy, Faculty of Public Health and Social Welfare, Riga Stradins University, Riga, Latvia
| | - Vicky Karkou
- Research Centre for Arts and Wellbeing, Edge Hill University, Ormskirk, United Kingdom
| | - Inga Millere
- Department of Health Psychology and Pedagogy, Faculty of Public Health and Social Welfare, Riga Stradins University, Riga, Latvia
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Saiklang P, Puntumetakul R, Swangnetr Neubert M, Boucaut R. The immediate effect of the abdominal drawing-in maneuver technique on stature change in seated sedentary workers with chronic low back pain. ERGONOMICS 2021:1-14. [PMID: 33190607 DOI: 10.1080/00140139.2020.1810326_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
Many studies have measured stature change arising from loads imposed on the spine during sitting. To improve stature recovery, it is important to stabilise the lumbar spine and compensate forces from the upper body. The abdominal drawing-in maneuver (ADIM) technique has been found to mainly activate deep trunk muscles. The purpose of this study was to determine whether activation of deep trunk muscles by the ADIM technique could immediately improve stature recovery during prolonged sitting. Twenty-four patients with chronic low back pain (CLBP) were randomly allocated into different orders of experimental conditions: control (sitting without ADIM technique) and intervention conditions (sitting with ADIM technique). The latter condition required participants to complete ADIM technique for 1 min and repeat it three times throughout 41 min prolonged sitting time. Stature recovery was improved by 3.292 mm in the intervention condition compared with control condition (p-value = 0.001). Our finding demonstrated that ADIM technique improved stature recovery. Practitioner Summary: Prolonged sitting seemingly harms sedentary workers' health, particularly affecting the lower back. Activation of deep trunk muscles using abdominal drawing-in maneuver technique can promote spinal recovery. Clinicians can teach abdominal drawing-in maneuver technique to activate deep trunk muscles in chronic low back pain, thereby promoting self-management of seated stature recovery. Abbrevations: ADIM: abdominal drawing-in maneuver; RA: rectus abdominis; ICLT: iliocostalis lumborum pars thoracis; LM: lumbar multifidus; TrA: transversus abdominis; IO: internal oblique; CLBP: chronic low back pain; LBP: low back pain; RMDQ: Roland Morris disability questionnaire; NRS: numerical rating scale.
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Affiliation(s)
- Pongsatorn Saiklang
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Rungthip Puntumetakul
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Manida Swangnetr Neubert
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Department of Production Technology, Faculty of Technology, Khon Kaen University, Khon Kaen, Thailand
| | - Rose Boucaut
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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Saiklang P, Puntumetakul R, Swangnetr Neubert M, Boucaut R. The immediate effect of the abdominal drawing-in maneuver technique on stature change in seated sedentary workers with chronic low back pain. ERGONOMICS 2021; 64:55-68. [PMID: 32799753 DOI: 10.1080/00140139.2020.1810326] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
Many studies have measured stature change arising from loads imposed on the spine during sitting. To improve stature recovery, it is important to stabilise the lumbar spine and compensate forces from the upper body. The abdominal drawing-in maneuver (ADIM) technique has been found to mainly activate deep trunk muscles. The purpose of this study was to determine whether activation of deep trunk muscles by the ADIM technique could immediately improve stature recovery during prolonged sitting. Twenty-four patients with chronic low back pain (CLBP) were randomly allocated into different orders of experimental conditions: control (sitting without ADIM technique) and intervention conditions (sitting with ADIM technique). The latter condition required participants to complete ADIM technique for 1 min and repeat it three times throughout 41 min prolonged sitting time. Stature recovery was improved by 3.292 mm in the intervention condition compared with control condition (p-value = 0.001). Our finding demonstrated that ADIM technique improved stature recovery. Practitioner Summary: Prolonged sitting seemingly harms sedentary workers' health, particularly affecting the lower back. Activation of deep trunk muscles using abdominal drawing-in maneuver technique can promote spinal recovery. Clinicians can teach abdominal drawing-in maneuver technique to activate deep trunk muscles in chronic low back pain, thereby promoting self-management of seated stature recovery. Abbrevations: ADIM: abdominal drawing-in maneuver; RA: rectus abdominis; ICLT: iliocostalis lumborum pars thoracis; LM: lumbar multifidus; TrA: transversus abdominis; IO: internal oblique; CLBP: chronic low back pain; LBP: low back pain; RMDQ: Roland Morris disability questionnaire; NRS: numerical rating scale.
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Affiliation(s)
- Pongsatorn Saiklang
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Rungthip Puntumetakul
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Manida Swangnetr Neubert
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Department of Production Technology, Faculty of Technology, Khon Kaen University, Khon Kaen, Thailand
| | - Rose Boucaut
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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YAĞCI N, CAVLAK U, BASKAN E, ÖZTOP M. Geriatrik bireylerde bel ağrısı riski. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.641324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Patel S, Achana F, Carnes D, Eldridge S, Ellard DR, Griffiths F, Haywood K, Hee SW, Mistry D, Mistry H, Nichols VP, Petrou S, Pincus T, Potter R, Sandhu HK, Stewart K, Taylor S, Underwood M, Matharu M. Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: a randomised controlled trial protocol (CHESS). BMJ Open 2020; 10:e033520. [PMID: 32284387 PMCID: PMC7200026 DOI: 10.1136/bmjopen-2019-033520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic headaches are poorly diagnosed and managed and can be exacerbated by medication overuse. There is insufficient evidence on the non-pharmacological approaches to helping people living with chronic headaches. METHODS AND ANALYSIS Chronic Headache Education and Self-management Study is a pragmatic randomised controlled trial to test the effectiveness and cost-effectiveness of a self-management education support programme on top of usual care for patients with chronic headaches against a control of usual care and relaxation. The intervention is a 2-day group course based on education, personal reflection and a cognitive behavioural approach, plus a nurse-led one-to-one consultation and follow-up over 8 weeks. We aim to recruit 689 participants (356 to the intervention arm and 333 to the control) from primary care and self-referral in London and the Midlands. The trial is powered to show a difference of 2.0 points on the Headache Impact Test, a patient-reported outcome measure at 12 months post randomisation. Secondary outcomes include health related quality of life, self-efficacy, social activation and engagement, anxiety and depression and healthcare utilisation. Outcomes are being measured at 4, 8 and 12 months. Cost-effectiveness will be expressed in terms of incremental cost per quality-adjusted life year gained. ETHICS AND DISSEMINATION This trial will provide data on effectiveness and cost-effectiveness of a self-management support programme for chronic headaches. The results will inform commissioning of services and clinical practice. North West - Greater Manchester East Research Ethics Committee have approved the trial. The current protocol version is 3.6 date 7 March 2019. TRIAL REGISTRATION NUMBER ISRCTN79708100.
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Affiliation(s)
- Shilpa Patel
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Felix Achana
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - David R Ellard
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Kirstie Haywood
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Siew Wan Hee
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dipesh Mistry
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Hema Mistry
- Warwick Medical School, Warwick Evidence, University of Warwick, Coventry, UK
| | - Vivien P Nichols
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Rachel Potter
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Kimberley Stewart
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Stephanie Taylor
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Martin Underwood
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Manjit Matharu
- University College London Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
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Bitenc-Jasiejko A, Konior K, Lietz-Kijak D. Meta-Analysis of Integrated Therapeutic Methods in Noninvasive Lower Back Pain Therapy (LBP): The Role of Interdisciplinary Functional Diagnostics. Pain Res Manag 2020; 2020:3967414. [PMID: 32256908 PMCID: PMC7109562 DOI: 10.1155/2020/3967414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/07/2020] [Indexed: 12/12/2022]
Abstract
Introduction. Lower back pain (LBP) is almost a problem of civilizations. Quite often, it is a consequence of many years of disturbed distribution of tension within the human body caused by local conditions (injuries, hernias, stenoses, spondylolisthesis, cancer, etc.), global factors (postural defects, structural integration disorders, lifestyle, type of activity, etc.), or systemic diseases (connective tissue, inflammation, tumours, abdominal aneurysm, and kidney diseases, including urolithiasis, endometriosis, and prostatitis). Therefore, LBP rehabilitation requires the use of integrated therapeutic methods, combining the competences of interdisciplinary teams, both in the process of diagnosis and treatment. Aim of the Study. Given the above, the authors of the article conducted meta-analysis of the literature in terms of integrated therapeutic methods, indicating the techniques focused on a holistic approach to the patient. The aim of the article is to provide the reader with comprehensive knowledge about treating LBP using noninterventional methods. Material and Methods. An extensive search for the materials was conducted online using PubMed, the Cochrane database, and Embase. The most common noninterventional methods have been described, as well as the most relevantly updated and previously referenced treatment of LBP. The authors also proposed noninvasive (measurable) diagnostic procedures for the functional assessment of the musculoskeletal system, including initial, systematic, and cross-sectional control. All figures and images have been prepared by the authors and are their property. Results This review article goes beyond combining a detailed description of each procedure with full references, as well as a comprehensive discussion of this very complex and troublesome problem. Conclusions Lower back pain is a serious health problem, and this review article will help educate physicians and physiotherapists dealing with LBP in the options of evidence-based treatment. Ultimately, the article introduces and postulates the need to systematize therapeutic procedures in LBP therapy, with a long-term perspective.
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Affiliation(s)
- Aleksandra Bitenc-Jasiejko
- Department of Propedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Danuta Lietz-Kijak
- Department of Propedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Saes MDO, Lopes JDN, Nunes BP, Duro SMS, Facchini LA, Thumé E. [Occurrence of spinal disorders and associated factors among the elderly: a population study in a municipality in the deep south of Brazil]. CIENCIA & SAUDE COLETIVA 2019; 26:739-747. [PMID: 33605348 DOI: 10.1590/1413-81232021262.33542018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/29/2019] [Indexed: 01/05/2023] Open
Abstract
The scope of this study was to estimate the prevalence of spinal disorders among the elderly and analyze potential associated factors. It involved a cross-sectional study of a sample of 1,593 elderly individuals aged 60 years or more residing in the urban area of Bagé, State of Rio Grande do Sul. In addition to the "spinal disorders" outcome, demographic, socioeconomic and behavioral variables, health perception, functional activities and the use of health services were investigated. Data collection was conducted by means of face-to-face interviews. Poisson regression analysis with robust variance was used to verify the factors associated with the outcome analyzed. Of the 1,593 participants, 37.4% reported spinal disorders. The factors related to the outcome were: low level of schooling, poor self-assessment of health, consultation in the last three months and the presence of hypertension, rheumatism and fractures. Interventions for musculoskeletal health can contribute to reduce the damages caused by spinal disorders among the elderly, such as loss of functional capacity, increased demands for health care and reduced quality of life.
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Affiliation(s)
- Mirelle de Oliveira Saes
- Faculdade de Medicina, Universidade Federal do Rio Grande. R. Visconde de Paranaguá 102, Campus da Saúde. 96203-900 Rio Grande RS Brasil.
| | | | - Bruno Pereira Nunes
- Faculdade de Enfermagem, Universidade Federal de Pelotas (UFPel). Pelotas RS Brasil
| | | | | | - Elaine Thumé
- Faculdade de Enfermagem, Universidade Federal de Pelotas (UFPel). Pelotas RS Brasil
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Prevalence and Characterization of Breakthrough Pain Associated with Chronic Low Back Pain in the South of Spain: A Cross-Sectional, Multicenter, Observational Study. PAIN RESEARCH AND TREATMENT 2018; 2018:4325271. [PMID: 29850241 PMCID: PMC5937435 DOI: 10.1155/2018/4325271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/02/2018] [Accepted: 03/17/2018] [Indexed: 11/17/2022]
Abstract
Chronic low back pain (CLBP) is highly prevalent in industrialized countries, where it is one of the main causes of disability. Patients with CLBP in treatment with opioids often experience episodes of breakthrough pain (BTP), but data on prevalence and treatment preferences are scarce. The objectives of this study were, first, the evaluation of the prevalence of BTP in patients with CLBP in the South of Spain (N = 1,868) and, second, the characterization of BTP in these patients (N = 295). Data was collected on presence of BTP, type and location of pain, treatment, compliance, and patient satisfaction. We found a prevalence of BTP in patients with CLBP of 37.5% (95% CI: 35.3%–39.7%), similar in men and women. 75% of the patients were older than 50 years. The preferred drug of patients who control BTP with opioids is fentanyl (78.3%) and its most common form of administration is nasal (53.2%). Therapeutic compliance was high and 46.3% of patients considered the control of their BTP very satisfactory. Our study showed that BTP is common in patients with CLBP and that current treatments seem adequate.
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Older adult's experience of chronic low back pain and its implications on their daily life: Study protocol of a systematic review of qualitative research. Syst Rev 2018; 7:81. [PMID: 29793522 PMCID: PMC5968538 DOI: 10.1186/s13643-018-0742-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/09/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Of various chronic diseases, low back pain (LBP) is the most common and debilitating musculoskeletal condition among older adults aged 65 years or older. While more than 17 million older adults in the USA suffer from at least one episode of LBP annually, approximately six million of them experience chronic LBP that significantly affects their quality of life and physical function. Since many older adults with chronic LBP may also have comorbidities and are more sensitive to pain than younger counterparts, these older individuals may face unique age-related physical and psychosocial problems. While some qualitative research studies have investigated the life experiences of older adults with chronic LBP, no systematic review has integrated and synthesized the scientific knowledge regarding the influence of chronic LBP on the physical, psychological, and social aspects of lives in older adults. Without such information, it may result in unmet care needs and ineffective interventions for this vulnerable group. Therefore, the objective of this systematic review is to synthesize knowledge regarding older adults' experiences of living with chronic LBP and the implications on their daily lives. METHODS/DESIGN Candidate publications will be sought from databases: PubMed, CINAHL, and PsycINFO. Qualitative research studies will be included if they are related to the experiences of older adults with chronic LBP. Two independent reviewers will screen the titles, abstracts, and full-text articles for eligibility. The reference lists of the included studies will be checked for additional relevant studies. Forward citation tracking will be conducted. Meta-ethnography will be chosen to synthesize the data from the included studies. Specifically, the second-order concepts that are deemed to be translatable by two independent reviewers will be included and synthesized to capture the core of the idiomatic translations (i.e., a translation focusing on salient categories of meaning rather than the literal translation of words or phrases). DISCUSSION This systematic review of qualitative evidence will enable researchers to identify potential unmet care needs, as well as to facilitate the development of effective, appropriate, person-centered health care interventions targeting this group of individuals. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2018: CRD42018091292.
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Müller-Schwefe G, Morlion B, Ahlbeck K, Alon E, Coaccioli S, Coluzzi F, Huygen F, Jaksch W, Kalso E, Kocot-Kępska M, Kress HG, Mangas AC, Margarit Ferri C, Mavrocordatos P, Nicolaou A, Hernández CP, Pergolizzi J, Schäfer M, Sichère P. Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Curr Med Res Opin 2017; 33:1199-1210. [PMID: 28277866 DOI: 10.1080/03007995.2017.1298521] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Chronic low back pain: Chronic pain is the most common cause for people to utilize healthcare resources and has a considerable impact upon patients' lives. The most prevalent chronic pain condition is chronic low back pain (CLBP). CLBP may be nociceptive or neuropathic, or may incorporate both components. The presence of a neuropathic component is associated with more intense pain of longer duration, and a higher prevalence of co-morbidities. However, many physicians' knowledge of chronic pain mechanisms is currently limited and there are no universally accepted treatment guidelines, so the condition is not particularly well managed. DIAGNOSIS Diagnosis should begin with a focused medical history and physical examination, to exclude serious spinal pathology that may require evaluation by an appropriate specialist. Most patients have non-specific CLBP, which cannot be attributed to a particular cause. It is important to try and establish whether a neuropathic component is present, by combining the findings of physical and neurological examinations with the patient's history. This may prove difficult, however, even when using screening instruments. Multimodal management: The multifactorial nature of CLBP indicates that the most logical treatment approach is multimodal: i.e. integrated multidisciplinary therapy with co-ordinated somatic and psychotherapeutic elements. As both nociceptive and neuropathic components may be present, combining analgesic agents with different mechanisms of action is a rational treatment modality. Individually tailored combination therapy can improve analgesia whilst reducing the doses of constituent agents, thereby lessening the incidence of side effects. CONCLUSIONS This paper outlines the development of CLBP and the underlying mechanisms involved, as well as providing information on diagnosis and the use of a wide range of pharmaceutical agents in managing the condition (including NSAIDs, COX-2 inhibitors, tricyclic antidepressants, opioids and anticonvulsants), supplemented by appropriate non-pharmacological measures such as exercise programs, manual therapies, behavioral therapies, interventional pain management and traction. Surgery may be appropriate in carefully selected patients.
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Affiliation(s)
| | | | | | - Eli Alon
- d Universitätsspital Zurich , Zurich , Switzerland
| | | | - Flaminia Coluzzi
- f Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy
| | - Frank Huygen
- g University Hospital , Rotterdam , The Netherlands
| | | | - Eija Kalso
- i Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine , University of Helsinki, and Helsinki University Hospital , Finland
| | - Magdalena Kocot-Kępska
- j Department of Pain Research and Treatment , Collegium Medicum Jagiellonian University , Kraków , Poland
| | - Hans-Georg Kress
- k Department of Special Anaesthesia and Pain Therapy , Medizinische Universität/AKH Wien , Vienna , Austria
| | | | | | | | | | | | | | - Michael Schäfer
- r Department of Anaesthesiology and Intensive Care Medicine , Charité University Berlin, Campus Virchow Klinikum , Berlin , Germany
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Genebra CVDS, Maciel NM, Bento TPF, Simeão SFAP, Vitta AD. Prevalence and factors associated with neck pain: a population-based study. Braz J Phys Ther 2017; 21:274-280. [PMID: 28602744 PMCID: PMC5537482 DOI: 10.1016/j.bjpt.2017.05.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/01/2016] [Accepted: 09/26/2016] [Indexed: 01/02/2023] Open
Abstract
The study population shows high prevalence of neck pain. The factors were widowed, income, educational level, sitting posture and diseases. Prevention should emphasize sociodemographic, behavioral, and ergonomic factors.
Background Neck pain is a musculoskeletal condition with high prevalence that may affect the physical, social, and psychological aspects of the individual, contributing to the increase in costs in society and business. Objective To determine the prevalence of neck pain and associated factors in a population-based sample of adults aged 20 and more. Methods Cross-sectional study based on a population survey. A total number of 600 individuals were interviewed in their homes, and the following data were collected: (1) participant characteristics (demographic, socioeconomic, and work-related aspects) using a pre-coded questionnaire; (2) physical activity level using the IPAQ; and (3) musculoskeletal symptoms using the Nordic questionnaire. Descriptive, bivariate, and Poisson regression analyses were performed. Results The prevalence of neck pain was 20.3% (95% CI 17.3–23.7). The adjusted analyses showed that individuals who were widowers or separated (PR = 2.26; 1.42–5.88), had a low income (PR = 1.32; 1.22–6.27) or low educational level (PR = 1.83; 1.02–5.26), worked while sitting and leaning (PR = 1.55; 1.08–2.40), and who reported having two or more diseases (PR = 1.71; 1.55–6.31) remained associated with neck pain. Conclusion This study reveals the high prevalence of neck pain and remarkable association with widowed/separated people who have low income and low educational level, who perform their occupational activities in sitting and leaning positions, and who reported having two or more diseases. Knowledge of these risk factors will contribute to the development of forms of assistance in which neck pain can be prevented and better managed.
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Affiliation(s)
| | - Nicoly Machado Maciel
- Programa de Mestrado em Fisioterapia na Saúde Funcional, Universidade do Sagrado Coração (USC), Bauru, SP, Brazil
| | | | | | - Alberto De Vitta
- Programa de Mestrado em Fisioterapia na Saúde Funcional, Universidade do Sagrado Coração (USC), Bauru, SP, Brazil.
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Wong AYL, Karppinen J, Samartzis D. Low back pain in older adults: risk factors, management options and future directions. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:14. [PMID: 28435906 PMCID: PMC5395891 DOI: 10.1186/s13013-017-0121-3] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/04/2017] [Indexed: 12/12/2022]
Abstract
Low back pain (LBP) is one of the major disabling health conditions among older adults aged 60 years or older. While most causes of LBP among older adults are non-specific and self-limiting, seniors are prone to develop certain LBP pathologies and/or chronic LBP given their age-related physical and psychosocial changes. Unfortunately, no review has previously summarized/discussed various factors that may affect the effective LBP management among older adults. Accordingly, the objectives of the current narrative review were to comprehensively summarize common causes and risk factors (modifiable and non-modifiable) of developing severe/chronic LBP in older adults, to highlight specific issues in assessing and treating seniors with LBP, and to discuss future research directions. Existing evidence suggests that prevalence rates of severe and chronic LBP increase with older age. As compared to working-age adults, older adults are more likely to develop certain LBP pathologies (e.g., osteoporotic vertebral fractures, tumors, spinal infection, and lumbar spinal stenosis). Importantly, various age-related physical, psychological, and mental changes (e.g., spinal degeneration, comorbidities, physical inactivity, age-related changes in central pain processing, and dementia), as well as multiple risk factors (e.g., genetic, gender, and ethnicity), may affect the prognosis and management of LBP in older adults. Collectively, by understanding the impacts of various factors on the assessment and treatment of older adults with LBP, both clinicians and researchers can work toward the direction of more cost-effective and personalized LBP management for older people.
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Affiliation(s)
- Arnold YL Wong
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR China
| | - Jaro Karppinen
- Medical Research Center Oulu, Department of Physical and Rehabilitation Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
- Finnish Institute of Occupational Health, Oulu, Finland
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR China
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Vitta AD, Conti MHSD, Maciel NM, Trize DDM, Corrente JE, Ruiz T. Prevalence and factors associated to back pain in adults from the northeast of São Paulo, Brazil: a population-based study. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.002.ao06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Back pain has become a serious public health problem. Objective: To determine the prevalence of back pain in a population-based sample of subjects over 20 years old living in the city of Bauru (São Paulo, Brazil) and to analyze the associations to variables- sociodemographic, ergonomic and lifestyle-related - and to morbidity. Methods: a cross-sectional study which evaluated 600 adults over 20 years old, both gender and living in the city. We used a structured protocol and the Nordic questionnaire. Also, we developed a descriptive analysis, bivariate and multivariate by binary logistic regression. Results: The prevalence of back pain was of 50.3% (CI 46.3 to 54.3), since 42.3% (CI 36.9 to 48.0) in men and 57.6% (CI 51.9 to 63.0) in women, with statistical significant difference (p = 0.001). Different variables remained in final models when assessed by gender. For male to be widowed and divorced and smoking habits and, for women to be widowed and divorced, to work in seated position and to perform occupational activities that demand carrying and lifting weight. Conclusion: We verified high prevalence in back pain in the population of Bauru and high association to widowed/divorced in both gender, with women performing occupational activities usually or always in seated position, those who carry or lift weight in work and men who smoke.
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Wong AY, Samartzis D. Low back pain in older adults - the need for specific outcome and psychometric tools. J Pain Res 2016; 9:989-991. [PMID: 27877064 PMCID: PMC5108615 DOI: 10.2147/jpr.s123538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Arnold Y Wong
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Special Administrative Region of China
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region of China
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Depintor JDP, Bracher ESB, Cabral DMC, Eluf-Neto J. Prevalence of chronic spinal pain and identification of associated factors in a sample of the population of São Paulo, Brazil: cross-sectional study. SAO PAULO MED J 2016; 134:375-384. [PMID: 27901240 PMCID: PMC10871843 DOI: 10.1590/1516-3180.2016.0091310516] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/31/2016] [Indexed: 01/21/2023] Open
Abstract
CONTEXT AND OBJECTIVE: Chronic spinal pain, especially low-back pain and neck pain, is a leading cause of years of life with disability. The aim of the present study was to estimate the prevalence of chronic spinal pain among individuals aged 15 years or older and to identify the factors associated with it. DESIGN AND SETTING: Cross-sectional epidemiological study on a sample of the population of the city of São Paulo. METHOD: Participants were selected using random probabilistic sampling and data were collected via face-to-face interviews. The Hospital Anxiety and Depression Scale (HADS), EuroQol-5D, Alcohol Use Disorders Identification Test (AUDIT), Fagerström test for nicotine dependence and Brazilian economic classification criteria were used. RESULTS: A total of 826 participants were interviewed. The estimated prevalence of chronic spinal pain was 22% (95% confidence interval, CI: 19.3-25.0%). The factors independently associated with chronic spinal pain were: female sex, age 30 years or older, schooling level of four years or less, symptoms compatible with anxiety and high physical exertion during the main occupation. Quality of life and self-rated health scores were significantly worse among individuals with chronic spinal pain. CONCLUSION: The prevalence of chronic spinal pain in this segment of the population of São Paulo was 22.0%. The factors independently associated with chronic pain were: female sex, age 30 years or older, low education, symptoms compatible with anxiety and physical exertion during the main occupation.
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Affiliation(s)
| | | | | | - José Eluf-Neto
- MD, PhD. Professor, Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
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Patient Satisfaction with Spanish Pain Centers: Observational Study with More than 3,000 Patients. PAIN RESEARCH AND TREATMENT 2016; 2016:7829585. [PMID: 27516902 PMCID: PMC4969540 DOI: 10.1155/2016/7829585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/19/2016] [Indexed: 11/18/2022]
Abstract
Chronic pain is a serious problem in Spain. This multicenter, epidemiological 3-month follow-up study investigates pain management efficacy in Spanish centers using patient satisfaction criteria. 3,414 eligible adult patients (65,6% female) with moderate to severe chronic pain from 146 pain centers were included. Patient satisfaction was assessed based onto question 18 of Spanish healthcare barometer-CSI. Pain evolution (Brief Pain Inventory-Short Form (BPI-SF) and visual analog scale (VAS)), quality of life/EuroQol-5, and pain control expectations fulfillment were also assessed. Mean age was 61.3 years. 64.4% of participating centers employed multidisciplinary pain management approach. After 3 months, mean patient satisfaction was 7.8 (1-10) on the CIS barometer. Medical staff received the highest scores, whereas waiting for tests, appointment request to appointment date time, and waiting times at the center the lowest. Mean pain decreased from 7.4 to 4.0; BPI-SF intensity decreased from 6.5 to 3.8; pain control expectations were met in 78.7% of patients; EuroQoL-5D utility index increased from 0.37 to 0.62, p < 0.001, and health status (VAS) from 40.6 to 61.9, p < 0.001. Chronic pain patients (90%) are satisfied with Spanish centers care; 80% had their pain control expectations met. Quality of life improved remarkably: 71% felt moderately to significantly better. However, waiting times need improvement.
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Wáng YXJ, Wáng JQ, Káplár Z. Increased low back pain prevalence in females than in males after menopause age: evidences based on synthetic literature review. Quant Imaging Med Surg 2016; 6:199-206. [PMID: 27190772 DOI: 10.21037/qims.2016.04.06] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Female sex hormones play an important role in the etiology and pathophysiology of a variety of musculoskeletal degenerative diseases. Postmenopausal women show accelerated disc degeneration due to relative estrogen deficiency. This literature review aims to validate or falsify this hypothesis, i.e., while overall females have higher prevalence of low back pain (LBP) across all age groups, this male vs. female difference in LBP prevalence further increases after female menopause age. The literature search was performed on PubMed on January 2, 2016. The search word combination was (low back pain) AND prevalence AND [(males OR men) AND (females OR women)]. The following criteria were taken to include the papers for synthetic analysis: (I) only English primary literatures on nonspecific pain; (II) only prospective studies on general population, but not population with occupational LBP causes, of both males and female subjects studied using the same LBP criterion, ages-specific information available, and males and female subjects were age-matched; (III) studies without major quality flaws. In total 98 studies with 772,927 subjects were analyzed. According to the information in the literature, participant subjects were divided into four age groups: (I) school age children group: 6-19 years; (II) young and middle aged group: 20-50 years; (III) mixed age group: data from studies did not differentiate age groups; (IV) elderly group: ≥50 years old. When individual studies were not weighted by participant number and each individual study is represented as one entry regardless of their sample size, the median LBP prevalence ratio of female vs. males was 1.310, 1.140, 1.220, and 1.270 respectively for the four age groups. When individual studies were weighted by participant number, the LBP prevalence ratio of female vs. males was 1.360, 1.127, 1.185, and 1.280 respectively for the four groups. The higher LBP prevalence in school age girls than in school age boys is likely due to psychological factors, female hormone fluctuation, and menstruation. Compared with young and middle aged subjects, a further increased LBP prevalence in females than in males was noted after menopause age.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Jùn-Qīng Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Zoltán Káplár
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Meucci RD, Fassa AG, Faria NMX. Prevalence of chronic low back pain: systematic review. Rev Saude Publica 2015; 49:S0034-89102015000100408. [PMID: 26487293 PMCID: PMC4603263 DOI: 10.1590/s0034-8910.2015049005874] [Citation(s) in RCA: 469] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/31/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex. METHODS We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex. RESULTS The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%. CONCLUSIONS Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level.
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Affiliation(s)
- Rodrigo Dalke Meucci
- Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
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Meucci RD, Fassa AG, Faria NMX, Fiori NS. Chronic low back pain among tobacco farmers in southern Brazil. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2015; 21:66-73. [PMID: 25633930 PMCID: PMC4273522 DOI: 10.1179/2049396714y.0000000094] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Despite tobacco farming involving intensive manual labor, chronic low back pain (CLBP) prevalence and associated factors are unknown among this occupational group. METHODS This was a cross-sectional study conducted in southern Brazil. A random sample of tobacco farmers was interviewed. Socioeconomic and individual characteristics, occupational tasks, workloads, and comorbidities were investigated. Chronic low back pain prevalence was described in relation to independent variables, and associations were examined with Poisson regression. RESULTS Chronic low back pain prevalence was 8·4%. Increasing age, rearing two or more species of livestock (PR 1·65), exposure to tasks that require heavy physical exertion (PR 2·00), working in awkward postures (PR 1·36), green tobacco sickness (GTS) (PR 1·63), pesticide poisoning (PR 2·37), and minor psychiatric disorders (PR 2·55) were associated with CLBP. CONCLUSIONS This study found that CLBP is a relevant health problem among tobacco farmers and highlights understudied risk factors such as pesticide poisoning and GTS. Policies to minimize exposure to physiological and chemical workloads in tobacco planting to prevent CLBP are needed. Health professionals should be trained to diagnose and prevent acute low back pain episodes and thus prevent/minimize limitations and disabilities due to CLBP.
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Prevalence of neck and low back pain in community-dwelling adults in Spain: an updated population-based national study (2009/10-2011/12). 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 2014; 24:482-92. [PMID: 25208501 DOI: 10.1007/s00586-014-3567-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 09/02/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To estimate time trends in the prevalence of neck (NP) and low back pain (LBP) from 2009 to 2012; and to determine the socio-demographic features, self-rated health status, co-morbidity, lifestyle-related habits, and health care service associated with NP and LBP in Spanish adults. OUTCOME MEASURES The European Health Interview Survey for Spain (2009) and the Spanish National Health Survey (2011). METHODS A total of 43,072 subjects were included. We analyzed data collected from the European Health Interview Survey for Spain conducted in 2009 (n = 22,188), and the Spanish National Health Survey in 2011 (n = 20,884). We considered the presence of isolated NP, LBP and both (NP&LBP). We analyzed socio-demographic features; self-perceived health status; lifestyle habits; comorbid diseases, and professional treatment using logistic regression models. RESULTS The prevalence of isolated NP, LBP and NP&LBP increased from 2008/9 to 2011/12 (7.86 vs. 8.56 %; 5.18 vs.5.44 %; 10.61 vs.11.12 %, respectively). Being female, increased the probability of isolated NP and NP&LBP, but decreased the probability of LBP. The prevalence of all pain localizations increased with older age, lower education level, poor self-rated health, smoker, comorbidities, psychological distress (anxiety or depression), hospital and physiotherapist visits and consumed drugs for pain, in 2008/9 as compared to 2011/12. Moreover, LBP, and NP&LBP were associated with obesity, whereas NP&LBP was associated with being married. CONCLUSIONS The prevalence of LBP, NP and NP&LBP had increased in the last 3 years in Spain.
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Vas J, Modesto M, Aguilar I, Gonçalo CDS, Rivas-Ruiz F. Efficacy and Safety of Auriculopressure for Primary Care Patients with Chronic Non-Specific Spinal Pain: A Multicentre Randomised Controlled Trial. Acupunct Med 2014; 32:227-35. [DOI: 10.1136/acupmed-2013-010507] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Chronic uncomplicated musculoskeletal pain in the spine (cervical, thoracic or lumbar) is highly prevalent and may severely limit the daily activities of those affected by it. Objective To evaluate the efficacy and safety of treatment with auriculopressure applied to patients with non-specific spinal pain. Methods A multicentre randomised controlled trial with two parallel arms (true auriculopressure (TAP) and placebo auriculopressure (PAP)) was performed. The intervention phase lasted 8 weeks and outcomes were measured 1 week after the last intervention (T1) and 6 months after baseline (T2). The primary outcome measure was change in pain intensity according to a 100 mm visual analogue scale (pain VAS) at T1. Secondary outcome measures were the Lattinen index, the McGill Pain Questionnaire and the SF-12 health-related quality of life scale (Spanish version in every case). Results There were 265 participants (TAP group, n=130; PAP group, n=135). Pain was most frequently located in the upper back (55.1%, n=146), followed by the lower back (25.3%, n=67) and the dorsal area (12.5%, n=33). Nineteen patients (7.2%) reported pain affecting the entire spine. There were statistically significant differences between TAP and PAP in the change in the pain VAS at T1 of 10 mm (95% CI 2.8 to 17.3, p=0.007) and in the change in the pain VAS at T2 of 7.2 mm (95% CI 0.02 to 14.3, p=0.049) in favour of TAP. We also observed a statistically significant difference of 3.4 points in the physical component of the SF-12 in favour of TAP at T2 (95% CI 0.45 to 6.3, p=0.024). No severe adverse effects were detected or reported during treatment. Conclusions The application of auriculopressure in patients with non-specific spinal pain in primary healthcare is effective and safe, and therefore should be considered for inclusion in the portfolio of primary healthcare services. Trial Registration Number ISRCTN01897462.
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Affiliation(s)
- Jorge Vas
- Pain Treatment Unit, Doña Mercedes Primary Health Care Centre, Dos Hermanas, Spain
- Carlos III Health Institute, Network of Research in Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
| | - Manuela Modesto
- Pain Treatment Unit, Doña Mercedes Primary Health Care Centre, Dos Hermanas, Spain
| | - Inmaculada Aguilar
- Pain Treatment Unit, Doña Mercedes Primary Health Care Centre, Dos Hermanas, Spain
| | | | - Francisco Rivas-Ruiz
- Carlos III Health Institute, Network of Research in Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
- Support Research Unit, Costa del Sol Hospital, Marbella, Spain
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Cid J, De La Calle JL, López E, Del Pozo C, Perucho A, Acedo MS, Bedmar D, Benito J, De Andrés J, Díaz S, García JA, Gómez-Caro L, Gracia A, Hernández JM, Insausti J, Madariaga M, Moñino P, Ruiz M, Uriarte E, Vidal A. A Modified Delphi Survey on the Signs and Symptoms of Low Back Pain: Indicators for an Interventional Management Approach. Pain Pract 2013; 15:12-21. [DOI: 10.1111/papr.12135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 09/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- José Cid
- Pain Unit; Department of Anesthesiology and Reanimation; “Virgen de la Salud” University Hospital; Toledo Hospital Complex; Toledo Spain
| | - José L. De La Calle
- Pain Study and Treatment Unit; “Ramón y Cajal” University Hospital; Madrid Spain
| | - Esther López
- Pain Unit; Department of Anesthesiology and Reanimation; Gregorio Marañón University General Hospital; Madrid Spain
| | | | - Alfredo Perucho
- Pain Study and Treatment Unit; “Ramón y Cajal” University Hospital; Madrid Spain
| | | | - Dolores Bedmar
- Pain Unit; Department of Anesthesiology; Fuenlabrada University Hospital; Madrid Spain
| | - Javier Benito
- Pain Unit; Department of Anesthesiology; “Ruber Internacional” Hospital; Madrid Spain
| | - Javier De Andrés
- Pain Unit; Department of Anesthesiology and Reanimation; “Virgen de la Salud” University Hospital; Toledo Hospital Complex; Toledo Spain
| | - Susana Díaz
- Pain Unit; Department of Anesthesiology and Reanimation; Gregorio Marañón University General Hospital; Madrid Spain
| | - Juan Antonio García
- Pain Unit; Department of Anesthesiology and Reanimation; “Infanta Cristina” University Hospital; Parla Madrid Spain
| | - Leticia Gómez-Caro
- Pain Unit; Department of Anesthesiology and Reanimation; “Virgen de la Salud” University Hospital; Toledo Hospital Complex; Toledo Spain
| | - Adolfo Gracia
- Pain Unit; Jiménez-Díaz Foundation University Hospital; Madrid Spain
| | | | | | - María Madariaga
- Pain Unit; Department of Anesthesiology and Reanimation; “Infanta Sofía” University Hospital; Madrid Spain
| | - Pedro Moñino
- Pain Unit; Department of Anesthesiology and Reanimation; “San Carlos” Clínical Hospital; Madrid Spain
| | - Manuel Ruiz
- Department of Anesthesiology and Reanimation, Prince of Asturias University; Hospital, Alcalá de Henares; Madrid Spain
| | - Estrella Uriarte
- Pain Unit, Department of Anesthesiology and Reanimation; “Severo Ochoa” University Hospital, Leganés; Madrid Spain
| | - Alfonso Vidal
- Pain Unit, Department of Anesthesiology; idcsalud Group Sur Hospital, Alcorcón; Madrid Spain
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He W, Sheng ZM, Wang L, Gaischek I, Litscher G. Modulation of Autonomic Nervous System During and After Acupuncture Treatment of Lumbosacral Pain in Women: A Preliminary Clinical Observational Study. Med Acupunct 2013. [DOI: 10.1089/acu.2012.0884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wei He
- Stronach Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, and TCM Research Center Graz, Medical University of Graz, Graz, Austria
- Department of Meridians, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ze-Min Sheng
- Stronach Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, and TCM Research Center Graz, Medical University of Graz, Graz, Austria
- Privatclinic Lassnitzhoehe, Lassnitzhoehe, Austria
| | - Lu Wang
- Stronach Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, and TCM Research Center Graz, Medical University of Graz, Graz, Austria
| | - Ingrid Gaischek
- Stronach Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, and TCM Research Center Graz, Medical University of Graz, Graz, Austria
| | - Gerhard Litscher
- Stronach Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, and TCM Research Center Graz, Medical University of Graz, Graz, Austria
- Department of Meridians, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
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