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Nørtoft M, Ettrup Christiansen C, Lund L, Sørensen D, Rossen CB. How does mHealth influence consulting practice between health professionals and individuals with low back pain? - A qualitative study from the perspective of health professionals. Disabil Rehabil 2024; 46:4129-4139. [PMID: 37791642 DOI: 10.1080/09638288.2023.2264186] [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: 02/16/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE This study explored how health professionals experience in what way a digital self-monitoring solution influences their consulting practice targeting individuals with low back pain. MATERIAL AND METHODS This was a qualitative study adopting a constructivist grounded theory approach. Nineteen health professionals participated in the pilot test of the digital self-monitoring solution BackTrace. Data were collected cross-sectionally and consisted of: (a) audio recordings from focus groups with health professionals, (b) field notes from participant observation of online meetings with health professionals, (c) field notes from participant observations of consultations between health professionals and individuals with low back pain and (d) audio recordings from workshops with health professionals. RESULTS Two main themes and one sub-theme were identified, describing how BackTrace enabled more focused consulting practices, supported patient-self management and improved the relationship between individuals with low back pain and health professionals. Barriers were identified describing how the implementation of digital health solutions required a change in workflow, resources and culture - as well as management support. CONCLUSIONS Findings indicated a need for a change at the system level, including a changed view of digitisation in healthcare systems containing a more supporting approach.
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Affiliation(s)
- Mette Nørtoft
- School of Nursing, VIA University College, Silkeborg, Denmark
| | | | - Lea Lund
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Dorthe Sørensen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark
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Lam SA, Zadro JR, Maher CG, San Juan C, Wang H, Ferreira GE. People With Acute Low Back Pain Have Concerns That May Not Be Addressed by Guideline-Recommended Advice: A Mixed-Methods Study. J Orthop Sports Phys Ther 2024; 54:575-583. [PMID: 39213307 DOI: 10.2519/jospt.2024.12571] [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] [Indexed: 09/04/2024]
Abstract
OBJECTIVE: To investigate what concerns people with acute low back pain (LBP) and explore whether demographic and clinical factors were associated with having concerns about LBP. DESIGN: Mixed-methods study. METHODS: We included participants aged ≥18 years with acute LBP (LBP≤6 weeks). We collected demographic and clinical characteristics via an online survey and asked one open-ended question to elicit participants' concerns about their LBP. We investigated concerns about LBP using inductive content analysis. Using multivariable logistic regression, we explored associations between demographic and clinical characteristics and having concerns about LBP. RESULTS: We included 2025 participants, a majority of whom (n = 1200, 59.3%) reported having at least 1 concern about their LBP. There were 34 unique concerns, which mapped to 5 themes: causes of LBP (n = 393, 19.4%), future consequences of LBP (n = 390, 19.3%), psychosocial consequences of LBP (n = 287, 14.2%), physical consequences of LBP (n = 210, 10.4%), and health consequences of LBP (n = 84, 4.2%). Demographic and clinical characteristics were associated with having concerns about LBP: participants with university education, having previously received advice for LBP, with higher LBP intensity, interference, and higher anxiety symptoms were more likely to have concerns about their LBP. CONCLUSION: Most people with acute LBP had at least 1 concern about their LBP, more commonly centered around the causes of and the future consequences of LBP. J Orthop Sports Phys Ther 2024;54(9):1-9. Epub 7 August 2024. doi:10.2519/jospt.2024.12571.
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Tidmarsh LV, Harrison R, Finlay KA. Prehabilitation: The underutilised weapon for chronic pain management. Br J Pain 2024; 18:354-364. [PMID: 39092207 PMCID: PMC11289902 DOI: 10.1177/20494637241250239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Objective Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, psychological prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to 'prehabilitate' patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions. Methods Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed. Results Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention. Conclusions Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify who requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation.
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Affiliation(s)
- Lydia V. Tidmarsh
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Richard Harrison
- Centre for Integrative Neuroscience and Neurodynamics, University of Reading, Reading, UK
| | - Katherine A. Finlay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Macedo L, Di Pelino S, Santos VS, Richardson J, MacDermid J, Hancock M, Battie MC, Saragiotto BT, Hayden JA, Rushton A, Packham T, Freman M, Bray S, Griffin M, Hladysh G, Miller P, Attwell S. Implementation of back to living well, a community-based program for the tertiary prevention of low back pain: a study protocol. BMC Musculoskelet Disord 2024; 25:593. [PMID: 39068385 PMCID: PMC11283700 DOI: 10.1186/s12891-024-07712-7] [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: 05/06/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The current literature supports the effectiveness of exercise, education, and self-management interventions for the long-term management of persistent low back pain. However, there is significant uncertainty about the implementation of interventions related to barriers, facilitators, and patient's preferences. This study will evaluate the Back to Living Well program implementation from a participant and organizational perspective. More specifically we address the following objectives: 1) identify program barriers and facilitators from participants' perspectives, 2) identify factors related to program, personal and contextual factors that contribute to negative and positive outcomes, and outcome trajectories, 3) identify factors influencing participants' selection of an in-person or e-health program, and 4) evaluate program specific barriers and facilitators from the organization and care delivery perspectives. METHODS This study will utilize a mixed-method convergent design including a longitudinal cohort strand and a longitudinal qualitative interview strand. The RE-AIM framework will be used to assess program implementation. Participants (n = 90, 1:1: in person or virtual) who choose to register in the program as well as staff (n = 10 to 15) involved in the delivery of the program will be invited to participate. Participants will participate in a 12-week physical activity, education, and self-management program. Implementation outcomes will be measured at 3-, 6-, 12-months, and six months after the end of the follow-ups. Interview scripts and directed content analysis will be constructed based on the Theoretical Domains Framework and the Neuromatrix Model of Pain, Theoretical Domains Framework. Staff interviews will be constructed and analyzed using the Consolidated Framework for Implementation Research. Participants will also complete pain, disability, quality of life and psychological questionnaires, wear an activity tracker at all time points, and complete weekly pain and activity limitation questions using a mobile application. DISCUSSION The study results will provide evidence to inform potential future implementation of the program. An effective, appropriately targeted, and well implemented exercise program for the long-term management (i.e., tertiary prevention) of LBP could minimize the burden of the condition on patients, the health care system and society. TRIAL REGISTRATION ClinicalTrials.gov NCT05929846. This (Registration Date: July 3 2023) study has been approved by the Hamilton Integrated Research Ethics Board Project ID#15,354.
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Affiliation(s)
- Luciana Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
| | | | - Veronica Souza Santos
- School of Rehabilitation Science, McMaster University and Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Bruno T Saragiotto
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | | | - Tara Packham
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Matt Freman
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Steven Bray
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Meridith Griffin
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Pat Miller
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Samanna CL, Buntine P, Belavy DL, Sultana RV, Miller CT, Nimorakiotakis VB, Owen PJ. Adherence to low back pain clinical guidelines in Australian hospital emergency departments: A public and private comparison. Australas Emerg Care 2024:S2588-994X(24)00042-3. [PMID: 39068042 DOI: 10.1016/j.auec.2024.07.001] [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: 05/21/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
Managing LBP via clinical practice guidelines in healthcare settings is recommended, yet burgeoning evidence suggests adherence is suboptimal in emergency department settings. Whether adherence differs between public and private settings is unknown. A retrospective audit of two Australian emergency departments matched 86 private patients to 86 public patients by age ( ± 5 years), sex (male/female) and LBP duration (first time/history of LBP). Patient charts were reviewed according to the Australian clinical guidelines for the management of LBP. Guidelines were considered individually and via a collective guideline adherence score (GAS). Management GAS was lower in private patients compared to public patients (d [95 %CI]: -0.67 [-0.98, -0.36], P < 0.001). Public patients were more likely to have documentation of guideline-based advice (OR [95 %CI]: 4.4 [2.4, 8.4], P < 0.001) and less likely to be sent for imaging (OR [95 %CI]: 5.0 [2.6, 9.4], P < 0.001). Private patients were more likely to have documented screening for psychosocial risk factors (OR [95 %CI]: 21.8 [9.1, 52.1], P < 0.001) and more likely to receive guideline-based medication prescriptions at patient discharge (OR [95 %CI]: 2.2 [1.2, 4.2], P = 0.013). Differences exist in public and private hospital emergency department guideline adherence. Exploring barriers and facilitators underpinning these differences will assist in guiding future implementation science approaches.
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Affiliation(s)
- Claire L Samanna
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia.
| | - Paul Buntine
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Emergency Medicine Program, Eastern Health, Melbourne, Victoria, Australia.
| | - Daniel L Belavy
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Division of Physiotherapy, Gesundheitscampus 6-8, Bochum 44801, Germany.
| | | | - Clint T Miller
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
| | | | - Patrick J Owen
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Emergency Medicine Program, Eastern Health, Melbourne, Victoria, Australia.
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Augustine L, Zadro J, Maher C, Traeger AC, Jones C, West CA, Yang J, O'Keeffe M, Jenkins H, McAuley JH, Ferreira GE. Perceptions of advice for acute low back pain: a content analysis of qualitative data collected in a randomised experiment. BMJ Open 2024; 14:e079070. [PMID: 39043591 PMCID: PMC11268038 DOI: 10.1136/bmjopen-2023-079070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES To explore how people perceive three different forms of advice for acute low back pain (LBP). DESIGN Content analysis of qualitative data collected in a three-arm randomised experiment. PARTICIPANTS 2200 participants with acute LBP (ie, pain duration for ≤6 weeks) were randomly assigned to receive three types of advice: guideline advice and guideline advice with the addition of either brief pain science or ergonomics messages. PRIMARY AND SECONDARY OUTCOMES After receiving the advice, participants answered two questions: 'If your health professional gave you this advice, how would it make you feel?' and 'If your health professional gave you this advice, what treatments (if any) do you think you would need?' Two researchers coded responses using deductive content analysis. RESULTS We analysed 4400 free-text responses from 2200 participants. There were little to no differences in participants' feelings, thoughts and expectations after receiving three types of advice for acute LBP. Participants most commonly expressed feeling positive about the advice (38%-35%), reassured (23%-22%) and empowered (10%-8%). Some expressed being unhappy or being frustrated with the advice (4%-3%). Participants most commonly thought they needed no treatment apart from staying active, followed by exercise and medication. CONCLUSIONS Guideline advice with or without the addition of brief pain science or ergonomics messages generated positive feelings, reassurance or a sense of empowerment in many people with acute LBP, with no difference between types of advice. TRIAL REGISTRATION NUMBER ACTRN12623000364673.
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Affiliation(s)
- Lidiya Augustine
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joshua Zadro
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Christopher Maher
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Adrian C Traeger
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Caitlin Jones
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Courtney A West
- Institute for Musculoskeletal Health, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Jingjing Yang
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mary O'Keeffe
- National University of Ireland Galway, Galway, Ireland
| | - Hazel Jenkins
- Macquarie University, Sydney, New South Wales, Australia
| | - James H McAuley
- University of New South Wales, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Giovanni E Ferreira
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
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Kühn L, Kleist L, Weißenstein F, Choi KEA. Biomedical Dogmas Still Influence the Delivery of Exercise Therapy in Chronic Low Back Pain Management: Mixed-Methods Study. Patient Prefer Adherence 2024; 18:1493-1507. [PMID: 39050274 PMCID: PMC11268774 DOI: 10.2147/ppa.s462689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose Non-specific, chronic low back pain (NSCLBP) is a leading cause of disability, prompting long-term rehabilitation. Positive patient beliefs and expectations towards lasting exercise engagement play a crucial role for a successful management of this condition. The aim was to investigate beliefs, unmet needs and expectations of NSCLBP patients for exercise-related health behaviour change in the context of rehabilitative care. Patients and Methods In a mono-centric mixed-methods study, we conducted semi-structured interviews with NSCLBP patients and care providers. We recruited in a rehabilitation clinic which is specialized in orthopaedics and internal medicine. Interviews were analysed deductively by combining health behaviour change theories with Donabedian's quality model of care. In a patient survey, disability (RMDQ), exercise behaviours, fear avoidance beliefs (FABQ), self-efficacy in chronic disease management (SES6G), process- and outcome-expectations (OEE-2) were queried and analysed descriptively. Results Twenty-two interviews were conducted and 40 questionnaires completed. Qualitative results revealed that NSCLBP patients had persistent biomedical perspectives on their health condition, marked by strong preferences for biomedical diagnostics and beliefs in the superiority of specific exercise regimes. Based on met expectations and positive movement experiences, patients' motivation was successfully fostered in the motivational phase of health behavior change. In the volitional phase, the postulated desire to receive self-management strategies was largely unmet. Psychosocial aspects of care were not widely accepted. The survey study sample showed a disability score (RMDQ) of M = 6.8 (±4.6). Mean scores of validated scales reflecting on attitudes, beliefs and expectations of chronic NSCLBP management were at FABQ-pa M = 15.4 (±6.0), FABQ-w M = 24.0 (±12.1), SES6G M = 6.4 (±2.3), and OEE-2 M = 2.7 (±0.5). Conclusion In this sample, patients' understanding of NSCLBP was still dominated by biomedical dogmas and perspectives. Inpatient rehabilitation predominantly addressed expectations towards the motivational phase of exercise-related health behaviour change.
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Affiliation(s)
- Lukas Kühn
- Center for Health Services Research, Brandenburg Medical School, Rüdersdorf bei Berlin, 15562, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, 16816, Germany
| | - Lara Kleist
- Center for Health Services Research, Brandenburg Medical School, Rüdersdorf bei Berlin, 15562, Germany
| | - Franziska Weißenstein
- Center for Health Services Research, Brandenburg Medical School, Rüdersdorf bei Berlin, 15562, Germany
| | - Kyung-Eun Anna Choi
- Center for Health Services Research, Brandenburg Medical School, Rüdersdorf bei Berlin, 15562, Germany
- Health Services Research, Research Center MIAAI (Medical Image Analysis & Artificial Intelligence), Danube Private University, Faculty of Medicine/Dentistry, Krems-Stein, 3500, Austria
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Bérubé M, Verret M, Bourque L, Côté C, Guénette L, Richard-Denis A, Ouellet S, Singer LN, Gauthier L, Gagnon MP, Gagnon MA, Martorella G. Educational needs and preferences of adult patients with acute pain: a mixed-methods systematic review. Pain 2024:00006396-990000000-00630. [PMID: 38888742 DOI: 10.1097/j.pain.0000000000003288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/28/2024] [Indexed: 06/20/2024]
Abstract
ABSTRACT Many patients experience acute pain, which has been associated with numerous negative consequences. Pain education has been proposed as a strategy to improve acute pain management. However, studies report limited effects with educational interventions for acute pain in adults, which can be explained by the underuse of the person-centered approach. Thus, we aimed to systematically review and synthetize current evidence from quantitative, qualitative and mixed-methods studies describing patients' needs and preferences for acute pain education in adults. We searched original studies and gray literature in 7 databases, from January 1990 to October 2023. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A total of 32 studies were included (n = 1847 patients), two-thirds of which were qualitative studies of high methodological quality. Most of the studies were conducted over the last 15 years in patients with postsurgical and posttraumatic pain, identified as White, with a low level of education. Patients expressed the greatest need for education when it came to what to expect in pain intensity and duration, as well how to take the medication and its associated adverse effects. The most frequently reported educational preferences were for in-person education while involving caregivers and to obtain information first from physicians, then by other professionals. This review has highlighted the needs and preferences to be considered in pain education interventions, which should be embedded in an approach cultivating communication and partnership with patients and their caregivers. The results still need to be confirmed with different patient populations.
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Affiliation(s)
- Mélanie Bérubé
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
| | - Michael Verret
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Laurence Bourque
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Caroline Côté
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
| | - Line Guénette
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Andréane Richard-Denis
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Centre, CIUSSS du Nord-de-l'île-de-Montréal, Montréal, QC, Canada
| | - Simon Ouellet
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, QC, Canada
| | - Lesley Norris Singer
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
| | - Lynn Gauthier
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de Recherche en Santé durable, Université Laval, Québec, QC, Canada
- Oncology Division, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Cancer Research Centre, Université Laval, Québec City, QC, Canada
| | - Marie-Pierre Gagnon
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de Recherche en Santé durable, Université Laval, Québec, QC, Canada
| | - Marc-Aurèle Gagnon
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Géraldine Martorella
- College of Nursing, Florida State University, Tallahassee, FL, United States
- Florida State University Brain Science and Symptom Management Center, Tallahassee, FL, United States
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Lee SB, Yoon J, Park SJ, Chae DS. Expandable Cages for Lumbar Interbody Fusion: A Narrative Review. J Clin Med 2024; 13:2889. [PMID: 38792431 PMCID: PMC11122612 DOI: 10.3390/jcm13102889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Lumbar fusion surgery for treating degenerative spinal diseases has undergone significant advancements in recent years. In addition to posterior instrumentation, anterior interbody fusion techniques have been developed along with various cages for interbody fusion. Recently, expandable cages capable of altering height, lordotic angle, and footprint within the disc space have garnered significant attention. In this manuscript, we review the current status, clinical outcomes, and future prospects of expandable cages for lumbar interbody fusion based on the existing literature. Expandable cages are suitable for minimally invasive spinal surgeries. Small-sized cages can be inserted and subsequently expanded to a larger size within the disc space. While expandable cages generally demonstrate superior clinical outcomes compared to static cages, some studies have suggested comparable or even poorer outcomes with expandable cages than static cages. Careful interpretation through additional long-term follow-ups is required to assess the utility of expandable cages. If these shortcomings are addressed and the advantages are further developed, expandable cages could become suitable surgical instruments for minimally invasive spinal surgeries.
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Affiliation(s)
- Soo-Bin Lee
- Department of Orthopedic Surgery, Catholic Kwandong University International St. Mary’s Hospital, Incheon 22711, Republic of Korea;
| | - Jonghun Yoon
- Department of Mechanical Engineering, Hanyang University, Ansan 15588, Republic of Korea
| | - Sung-Jun Park
- School of Mechanical, Automotive and Aeronautical Engineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
| | - Dong-Sik Chae
- Department of Orthopedic Surgery, Catholic Kwandong University International St. Mary’s Hospital, Incheon 22711, Republic of Korea;
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Apeldoorn AT, Swart NM, Conijn D, Meerhoff GA, Ostelo RW. Management of low back pain and lumbosacral radicular syndrome: the Guideline of the Royal Dutch Society for Physical Therapy (KNGF). Eur J Phys Rehabil Med 2024; 60:292-318. [PMID: 38407016 PMCID: PMC11112513 DOI: 10.23736/s1973-9087.24.08352-7] [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: 11/26/2023] [Revised: 01/08/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Significant progress and new insights have been gained since the Dutch Physical Therapy guideline on low back pain (LBP) in 2013 and the Cesar en Mensendieck guideline in 2009, necessitating an update of these guidelines. AIM To update and develop an evidence-based guideline for the comprehensive management of LBP and lumbosacral radicular syndrome (LRS) without serious specific conditions (red flags) for Dutch physical therapists and Cesar and Mensendieck Therapists. DESIGN Clinical practice guideline. SETTING Inpatient and outpatient. POPULATION Adults with LBP and/or LRS. METHODS Clinically relevant questions were identified based on perceived barriers in current practice of physical therapy. All clinical questions were answered using published guidelines, systematic reviews, narrative reviews or systematic reviews performed by the project group. Recommendations were formulated based on evidence and additional considerations, as described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework. Patients participated in every phase. RESULTS The guideline describes a comprehensive assessment based on the International Classification of Functioning, Disability and Health (ICF) Core Set for LBP and LRS, including the identification of alarm symptoms and red flags. Patients are assigned to three treatment profiles (low, moderate and high risk of persistent symptoms) based on prognostic factors for persistent LBP. The guideline recommends offering simple and less intensive support to people who are likely to recover quickly (low-risk profile) and more complex and intensive support to people with a moderate or high risk of persistent complaints. Criteria for initiating and discontinuing physical therapy, and referral to a general practitioner are specified. Recommendations are formulated for information and advice, measurement instruments, active and passive interventions and behavior-oriented treatment. CONCLUSIONS An evidence based physical therapy guideline for the management of patients with LBP and LRS without red flags for physical therapists and Cesar and Mensendieck therapists was developed. Cornerstones of physical therapy assessment and treatment are risk stratification, shared decision-making, information and advice, and exercises. CLINICAL REHABILITATION IMPACT This guideline provides guidance for clinicians and patients to optimize treatment outcomes in patients with LBP and LRS and offers transparency for other healthcare providers and stakeholders.
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Affiliation(s)
- Adri T Apeldoorn
- Department of Rehabilitation, Noordwest Ziekenhuisgroep Alkmaar, Alkmaar, the Netherlands -
| | - Nynke M Swart
- Royal Dutch Society of Physical Therapy, Amersfoort, the Netherlands
| | - Daniëlle Conijn
- Royal Dutch Society of Physical Therapy, Amersfoort, the Netherlands
| | - Guus A Meerhoff
- Royal Dutch Society of Physical Therapy, Amersfoort, the Netherlands
| | - Raymond W Ostelo
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Free University, Amsterdam, the Netherlands
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11
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Almeida VC, Pereira LCD, Machado SDC, Maciel LYDS, de Farias Neto JP, de Santana Filho VJ. The use of a biopsychosocial model in the treatment of patients with chronic. PATIENT EDUCATION AND COUNSELING 2024; 121:108117. [PMID: 38183922 DOI: 10.1016/j.pec.2023.108117] [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: 08/17/2023] [Revised: 11/21/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVE To explore the available knowledge on the application of biopsychosocial model (BPS) in patients with chronic low back pain (CLBP). METHODS A scoping review, including 32 papers that used a BPS to manage adult patients with CLBP, published in any language. Six different databases were searched. RESULTS According to the description of the protocols, most of them use BPS for assessment of the patients. In this first stage the most often evaluated were pain and disability, kinesiophobia and quality of life, and work-related factors. The intervention most used associate psychological and physical domains using pain education or cognitive functional therapy and active exercise. Even though was not the most common, in the social domain occupational, behavioral and family interventions were observed. CONCLUSION BPS is more often used as combination of physical and psychological aspects, being the social domain restricted to work-related factors. Patien'ts perception of their health status is little explored, and it is suggested that the International Classification of Functioning, Disability and Health be used. PRACTICE IMPLICATION Patient perception as well as social factors in addition to occupational ones should be included in the clinical approach of the patient with CLBP and should be further explored in research.
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Affiliation(s)
- Verena Calmon Almeida
- Graduate Program in Health Science, Federal University of Sergipe, Aracaju 49100-000, Sergipe, Brazil; Research Center in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sports, University of Porto (FADEUP), 4200-450 Porto, Portugal.
| | | | - Saulo da Cunha Machado
- Graduate Program in Health Science, Federal University of Sergipe, Aracaju 49100-000, Sergipe, Brazil
| | - Leonardo Yung Dos Santos Maciel
- Research Center in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sports, University of Porto (FADEUP), 4200-450 Porto, Portugal; Physiotherapy Department, Federal University of Sergipe, 49100-000 Lagarto, Sergipe, Brazil
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12
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Ray BM, Washington L, Thompson BL, Kelleran K. An exploration of low back pain beliefs held by health care professionals in Northern America. Musculoskeletal Care 2024; 22:e1877. [PMID: 38520493 DOI: 10.1002/msc.1877] [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: 02/26/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Prior research demonstrated that people in the United States and Canada (Northern America) hold predominantly biomedical beliefs about Low back pain (LBP); such beliefs were attributed to healthcare professionals (HCP). Further investigation is needed to understand HCP' LBP beliefs, preferred management strategies, and sources of beliefs. METHODS Participants were recruited via social media to complete a qualitative cross-sectional online survey. The survey was distributed to assess LBP beliefs in a U.S. and Canadian-based clinician population. Participants answered questions about the cause of LBP, reasons for recurrence or persistence, use of imaging, management strategies, and sources of beliefs. Responses were analysed using an inductive thematic analysis. RESULTS One hundred and sixty three participants were included, reporting multiple causes for LBP. However, many references were anchored to biological problems. When psychological variables were mentioned, it typically involved patient blaming. Like prior research studies, minimal attention was given to societal and environmental influences. Management strategies often aligned with guideline care except for the recommendation of inappropriate imaging and a reliance on passive interventions. CONCLUSIONS These findings align with prior research studies on general population beliefs, demonstrating a preference for biological causes of LBP. Further updates are needed for clinical education, while future studies should seek to assess the translation of clinician beliefs into clinical practice and health system constraints.
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Affiliation(s)
- B Michael Ray
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, Virginia, USA
| | - Leah Washington
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, Virginia, USA
| | - Bronwyn Lennox Thompson
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand, USA
| | - Kyle Kelleran
- Department of Emergency Medicine, University at Buffalo, Buffalo, New York, USA
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13
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Kragting M, Pool-Goudzwaard AL, Coppieters MW, O'Sullivan PB, Voogt L. Illness perceptions in people with chronic and disabling non-specific neck pain seeking primary healthcare: a qualitative study. BMC Musculoskelet Disord 2024; 25:179. [PMID: 38413876 PMCID: PMC10900625 DOI: 10.1186/s12891-024-07302-7] [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: 10/26/2023] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Illness perceptions can affect the way people with musculoskeletal pain emotionally and behaviorally cope with their health condition. Understanding patients illness perceptions may help facilitate patient-centered care. The purpose of this study was to explore illness perceptions and the origin of those perceptions in people with chronic disabling non-specific neck pain seeking primary care. METHODS A qualitative study using a deductive and inductive analytical approach was conducted in 20 people with persistent (> 3 months) and disabling (i.e., Neck Disability Index ≥ 15) neck pain. Using a semi-structured format, participants were interviewed about their illness perceptions according to Leventhal's Common Sense Model. Purposive sampling and member checking were used to secure validity of study results. RESULTS Participants reported multiple symptoms, thoughts and emotions related to their neck pain, which continuously required attention and action. They felt trapped within a complex multifactorial problem. Although some participants had a broader biopsychosocial perspective to understand their symptoms, a biomedical perspective was dominant in the labelling of their condition and their way of coping (e.g., limiting load, building strength and resilience, regaining mobility, keep moving and being meaningful). Their perceptions were strongly influenced by information from clinicians. Several participants indicated that they felt uncertain, because the information they received was contradictory or did not match their own experiences. CONCLUSION Most participants reported that understanding their pain was important to them and influenced how they coped with pain. Addressing this 'sense making process' is a prerequisite for providing patient-centered care.
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Affiliation(s)
- Maaike Kragting
- Department of Physical Therapy, Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam, 3015 EK, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annelies L Pool-Goudzwaard
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Somt University of Physiotherapy, Amersfoort, The Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Peter B O'Sullivan
- School of Allied Health, Curtin University, Bentley, Australia
- Body Logic Physiotherapy Clinic, Shenton Park, Australia
| | - Lennard Voogt
- Department of Physical Therapy, Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam, 3015 EK, The Netherlands.
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
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Huisman D, Burrows T, Sweeney L, Bannister K, Moss-Morris R. 'Symptom-free' when inflammatory bowel disease is in remission: Expectations raised by online resources. PATIENT EDUCATION AND COUNSELING 2024; 119:108034. [PMID: 37952400 DOI: 10.1016/j.pec.2023.108034] [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: 07/12/2023] [Revised: 10/03/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Up to 60% of patients with inflammatory bowel disease (IBD) experience symptoms when in remission. Qualitative research suggests patients seldom feel they receive adequate explanations for these. This study explores how, and how often, ongoing symptoms during remission are represented on readily searchable patient websites. METHODS Bing, Google, and Yahoo were searched for websites providing medical information about IBD. Thematic analysis was used to inductively explore themes around symptoms during quiescent IBD, followed by deductive content analysis to quantify core themes. RESULTS Results indicated that remission is commonly defined as "few or no symptoms" and that there is limited information available on symptoms during remission. 55.6% of IBD websites provided a definition of remission based on symptom control only, while 44.4% also incorporated inflammatory control. The few websites that mentioned that symptoms may continue during remission (21.7%) related these to IBS. CONCLUSIONS Current website information is predominantly biomedical and fails to adequately explain how symptoms may persist during remission and how IBS and IBD may be linked. PRACTICE IMPLICATIONS Lack of explanatory models of symptoms in remission may lead to distress and increase anxiety about symptoms. Clearer explanations of these symptoms are needed.
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Affiliation(s)
| | - Taylor Burrows
- Health Psychology Section, King's College London, London, UK
| | - Louise Sweeney
- Health Psychology Section, King's College London, London, UK
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Gomes LA, Rodrigues AM, van der Windt D, Pires D, Afreixo V, Canhão H, Cruz EB. Minimal Intervention of Patient Education for Low Back Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2024; 54:107-119. [PMID: 37970797 DOI: 10.2519/jospt.2023.11865] [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] [Indexed: 11/19/2023]
Abstract
OBJECTIVE: To explore the effects of minimal intervention of patient education (MIPE) for reducing disability and pain intensity in patients with low back pain (LBP). DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials. LITERATURE SEARCH: We searched the MEDLINE, Embase, CENTRAL, CINAHL, and PsycINFO databases from inception to May 2023. STUDY SELECTION CRITERIA: Trials comparing MIPE, consisting of a single session of patient education, to no or other interventions in patients with LBP. DATA SYNTHESIS: Random effects meta-analysis was conducted where possible. A noninferiority margin of 5 points (0-100 scale) was considered for noninferiority hypotheses. We assessed risk of bias using the revised Cochrane risk-of-bias tool (RoB 2), and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. RESULTS: A total of 21 trials were included. There were no differences between MIPE and no intervention for effects on disability and pain intensity. There was low-certainty evidence that MIPE had inferior effects on short-term disability (mean difference = 3.62; 95% CI: 0.85, 6.38; 15 trials; n = 3066; I2 = 75%) and pain intensity (mean difference = 9.43; 95% CI: 1.31, 17.56; 10 trials; n = 1394; I2 = 90%) than other interventions. No differences were found for subsequent time points. CONCLUSION: As an intervention delivered in isolation, and without tailoring (ie, one-size-fits-all intervention), MIPE on average did not provide benefits for reducing disability and pain intensity over no or other interventions. We encourage clinicians to consider using additional/other or more tailored treatments when helping people manage LBP. J Orthop Sports Phys Ther 2024;54(2):1-13. Epub 16 November 2023. doi:10.2519/jospt.2023.11865.
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16
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Wirth B, Schweinhardt P. Personalized assessment and management of non-specific low back pain. Eur J Pain 2024; 28:181-198. [PMID: 37874300 DOI: 10.1002/ejp.2190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/22/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Low back pain (LBP), and in particular non-specific low back pain (NSLBP), which accounts for approximately 90% of LBP, is the leading cause of years lived with disability worldwide. In clinical trials, LBP is often poorly categorized into 'specific' versus 'non-specific' and 'acute' versus 'chronic' pain. However, a better understanding of the underlying pain mechanisms might improve study results and reduce the number of NSLBP patients. DATABASES AND DATA TREATMENT Narrative review. RESULTS NSLBP is a multi-dimensional, biopsychosocial condition that requires all contributing dimensions to be assessed and prioritized. Thereby, the assessment of the contribution of nociceptive, neuropathic and nociplastic pain mechanisms forms the basis for personalized management. In addition, psychosocial (e.g. anxiety, catastrophizing) and contextual factors (e.g. work situation) as well as comorbidities need to be assessed and individually weighted. Personalized treatment of NSLBP further requires individually choosing treatment modalities, for example, exercising, patient education, cognitive-behavioural advice, pharmacotherapy, as well as tailoring treatment within these modalities, for example, the delivery of tailored psychological interventions or exercise programs. As the main pain mechanism and psychosocial factors may vary over time, re-assessment is necessary and treatment success should ideally be assessed quantitatively and qualitatively. CONCLUSIONS The identification of the main contributing pain mechanism and the integration of the patients' view on their condition, including beliefs, preferences, concerns and expectations, are key in the personalized clinical management of NSLBP. In research, particular importance should be placed on accurate characterization of patients and on including outcomes relevant to the individual patient. SIGNIFICANCE STATEMENT Here, a comprehensive review of the challenges associated with the diagnostic label 'non-specific low back pain' is given. It outlines what is lacking in current treatment guidelines and it is summarized what is currently known with respect to individual phenotyping. It becomes clear that more research on clinically meaningful subgroups is needed to best tailor treatment approaches.
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Affiliation(s)
- Brigitte Wirth
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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17
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Moens M, Van Doorslaer L, Billot M, Eeckman E, Roulaud M, Rigoard P, Fobelets M, Goudman L. Examining the Type, Quality, and Content of Web-Based Information for People With Chronic Pain Interested in Spinal Cord Stimulation: Social Listening Study. J Med Internet Res 2024; 26:e48599. [PMID: 38289645 PMCID: PMC10865187 DOI: 10.2196/48599] [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: 04/29/2023] [Revised: 11/03/2023] [Accepted: 11/28/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The increased availability of web-based medical information has encouraged patients with chronic pain to seek health care information from multiple sources, such as consultation with health care providers combined with web-based information. The type and quality of information that is available on the web is very heterogeneous, in terms of content, reliability, and trustworthiness. To date, no studies have evaluated what information is available about neuromodulation on the web for patients with chronic pain. OBJECTIVE This study aims to explore the type, quality, and content of web-based information regarding spinal cord stimulation (SCS) for chronic pain that is freely available and targeted at health care consumers. METHODS The social listening tool Awario was used to search Facebook (Meta Platforms, Inc), Twitter (Twitter, Inc), YouTube (Google LLC), Instagram (Meta Platforms, Inc), blogs, and the web for suitable hits with "pain" and "neuromodulation" as keywords. Quality appraisal of the extracted information was performed using the DISCERN instrument. A thematic analysis through inductive coding was conducted. RESULTS The initial search identified 2174 entries, of which 630 (28.98%) entries were eventually withheld, which could be categorized as web pages, including news and blogs (114/630, 18.1%); Reddit (Reddit, Inc) posts (32/630, 5.1%); Vimeo (Vimeo, Inc) hits (38/630, 6%); or YouTube (Google LLC) hits (446/630, 70.8%). Most posts originated in the United States (519/630, 82.4%). Regarding the content of information, 66.2% (383/579) of the entries discussed (fully discussed or partially discussed) how SCS works. In total, 55.6% (322/579) of the entries did not elaborate on the fact that there may be >1 potential treatment choice and 47.7% (276/579) did not discuss the influence of SCS on the overall quality of life. The inductive coding revealed 4 main themes. The first theme of pain and the burden of pain (1274/8886, 14.34% coding references) explained about pain, pain management, individual impact of pain, and patient experiences. The second theme included neuromodulation as a treatment approach (3258/8886, 36.66% coding references), incorporating the background on neuromodulation, patient-centered care, SCS therapy, and risks. Third, several device-related aspects (1722/8886, 19.38% coding references) were presented. As a final theme, patient benefits and testimonials of treatment with SCS (2632/8886, 29.62% coding references) were revealed with subthemes regarding patient benefits, eligibility, and testimonials and expectations. CONCLUSIONS Health care consumers have access to web-based information about SCS, where details about the surgical procedures, the type of material, working mechanisms, risks, patient expectations, testimonials, and the potential benefits of this therapy are discussed. The reliability, trustworthiness, and correctness of web-based sources should be carefully considered before automatically relying on the content.
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Affiliation(s)
- Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- STIMULUS (reSearch and TeachIng neuroModULation Uz bruSsel) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Leen Van Doorslaer
- STIMULUS (reSearch and TeachIng neuroModULation Uz bruSsel) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maxime Billot
- PRISMATICS (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery) Lab, Poitiers University Hospital, Poitiers, France
| | - Edgard Eeckman
- ECHO Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Manuel Roulaud
- PRISMATICS (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery) Lab, Poitiers University Hospital, Poitiers, France
| | - Philippe Rigoard
- PRISMATICS (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery) Lab, Poitiers University Hospital, Poitiers, France
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, Poitiers, France
- Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Chasseneuil-du-Poitou, France
| | - Maaike Fobelets
- Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Institute for Teacher Education, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- STIMULUS (reSearch and TeachIng neuroModULation Uz bruSsel) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
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Burton W, Salsbury SA, Goertz CM. Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey. BMC Health Serv Res 2024; 24:125. [PMID: 38263013 PMCID: PMC10804504 DOI: 10.1186/s12913-024-10578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Healthcare systems (HCS) are challenged in adopting and sustaining comprehensive approaches to spine care that require coordination and collaboration among multiple service units. The integration of clinicians who provide first line, evidence-based, non-pharmacological therapies further complicates adoption of these care pathways. This cross-sectional study explored clinician perceptions about the integration of guideline-concordant care and optimal spine care workforce requirements within an academic HCS. METHODS Spine care clinicians from Duke University Health System (DUHS) completed a 26-item online survey via Qualtrics on barriers and facilitators to delivering guideline concordant care for low back pain patients. Data analysis included descriptive statistics and qualitative content analysis. RESULTS A total of 27 clinicians (57% response) responded to one or more items on the questionnaire, with 23 completing the majority of questions. Respondents reported that guidelines were implementable within DUHS, but no spine care guideline was used consistently across provider types. Guideline access and integration with electronic records were barriers to use. Respondents (81%) agreed most patients would benefit from non-pharmacological therapies such as physical therapy or chiropractic before receiving specialty referrals. Providers perceived spine patients expected diagnostic imaging (81%) and medication (70%) over non-pharmacological therapies. Providers agreed that receiving imaging (63%) and opioids (59%) benchmarks could be helpful but might not change their ordering practice, even if nudged by best practice advisories. Participants felt that an optimal spine care workforce would require more chiropractors and primary care providers and fewer neurosurgeons and orthopedists. In qualitative responses, respondents emphasized the following barriers to guideline-concordant care implementation: patient expectations, provider confidence with referral pathways, timely access, and the appropriate role of spine surgery. CONCLUSIONS Spine care clinicians had positive support for current tenets of guideline-concordant spine care for low back pain patients. However, significant barriers to implementation were identified, including mixed opinions about integration of non-pharmacological therapies, referral pathways, and best practices for imaging and opioid use.
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Affiliation(s)
- Wren Burton
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Osher Center for Integrative Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Christine M Goertz
- Implementation of Spine Health Innovations, Department of Orthopaedic Surgery, School of Medicine, 300 W. Morgan Street, Durham, NC, 27701, USA.
- Duke Clinical Research Institute, Musculoskeletal Research, Duke University, 300 W. Morgan Street, Durham, NC, 27701, USA.
- Duke-Margolis Center for Health Policy, Duke University, 300 W. Morgan Street, Durham, NC, 27701, USA.
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Ames H, Hestevik CH, Briggs AM. Acceptability, values, and preferences of older people for chronic low back pain management; a qualitative evidence synthesis. BMC Geriatr 2024; 24:24. [PMID: 38182977 PMCID: PMC10768085 DOI: 10.1186/s12877-023-04608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/16/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Chronic primary low back pain (CPLBP) and other musculoskeletal conditions represent a sizable attribution to the global burden of disability, with rates greatest in older age. There are multiple and varied interventions for CPLBP, delivered by a wide range of health and care workers. However, it is not known if these are acceptable to or align with the values and preferences of care recipients. The objective of this synthesis was to understand the key factors influencing the acceptability of, and values and preferences for, interventions/care for CPLBP from the perspective of people over 60 and their caregivers. METHODS We searched MEDLINE, CINAHL and OpenAlex, for eligible studies from inception until April 2022. We included studies that used qualitative methods for data collection and analysis; explored the perceptions and experiences of older people and their caregivers about interventions to treat CPLBP; from any setting globally. We conducted a best fit framework synthesis using a framework developed specifically for this review. We assessed our certainty in the findings using GRADE-CERQual. RESULTS All 22 included studies represented older people's experiences and had representation across a range of geographies and economic contexts. No studies were identified on caregivers. Older people living with CPLBP express values and preferences for their care that relate to therapeutic encounters and the importance of therapeutic alliance, irrespective of the type of treatment, choice of intervention, and intervention delivery modalities. Older people with CPLBP value therapeutic encounters that validate, legitimise, and respect their pain experience, consider their context holistically, prioritise their needs and preferences, adopt a person-centred and tailored approach to care, and are supported by interprofessional communication. Older people valued care that provided benefit to them, included interventions beyond analgesic medicines alone and was financially and geographically accessible. CONCLUSIONS These findings provide critical context to the implementation of clinical guidelines into practice, particularly related to how care providers interact with older people and how components of care are delivered, their location and their cost. Further research is needed focusing on low- and middle-income settings, vulnerable populations, and caregivers.
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Affiliation(s)
- Heather Ames
- The Norwegian Institute of Public Health, PO Box 222, 0213, Oslo, Skøyen, Norway.
| | | | - Andrew M Briggs
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
- Faculty of Health Sciences, Curtin University, PO Box U1987, Perth, 6845, Western Australia
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Hubeishy MH, Rolving N, Poulsen AG, Jensen TS, Rossen CB. Barriers to the use of clinical practice guidelines: a qualitative study of Danish physiotherapists and chiropractors. Disabil Rehabil 2024; 46:105-114. [PMID: 36537245 DOI: 10.1080/09638288.2022.2157501] [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: 05/19/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Low back pain (LBP) is the leading cause of disability worldwide. Providing evidence-based practice (EBP) for patients with LBP is more cost-effective compared with non-EBP. To help health care professionals provide EBP, several clinical practice guidelines have been published. However, a relatively poor uptake of the guidelines has been identified across various countries. To enhance future implementation of EBP, the aim of this study was to explore barriers to using LBP guidelines in clinical practice. MATERIALS AND METHODS A qualitative constructivist grounded theory design was employed in order to gain an in-depth understanding of the barriers. Semi-structured interviews (+/- observations) of nine physiotherapists and nine chiropractors from primary care in the Central Denmark Region were conducted. RESULTS Two key barriers were found to using guidelines in practice: (1) a scepticism due to doubts about validity and applicability of the guidelines, which emerged particularly among physiotherapists; and (2) a deep biomechanical professional identity, due to perceived role, interest, lack of skills, and patient preferences, which emerged particularly among chiropractors. CONCLUSIONS For guidelines to be better implemented in practice, these key barriers must be addressed in a tailored strategy. Furthermore, this study showed a difference in barriers between the two professions.
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Affiliation(s)
- Maja Husted Hubeishy
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Nanna Rolving
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anne Grøndahl Poulsen
- DEFACTUM, Public Health and Rehabilitation Research, Central Region Denmark, Aarhus, Denmark
| | - Tue Secher Jensen
- Diagnostic Center - Imaging Section, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Camilla Blach Rossen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
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Mullen N, Ashby S, Haskins R, Osmotherly P. The experiences and preferences of individuals living with a musculoskeletal disorder regarding prognosis: A qualitative study. Musculoskeletal Care 2023; 21:987-996. [PMID: 37139716 DOI: 10.1002/msc.1777] [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: 04/13/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
QUESTION(S) What are the experiences and preferences of individuals living with a musculoskeletal disorder regarding prognosis? DESIGN Exploratory phenomenological study. PARTICIPANTS Individuals aged 18-year or older currently experiencing a musculoskeletal disorder and receiving treatment from a physiotherapist. DATA ANALYSIS Data were collected through semi-structured interviews and analysed using inductive coding and thematic analysis. RESULTS Five themes were identified. First, participants described seeking a cause for their pain. This influenced their experience of prognosis as they perceived a diagnosis was required to inform their prognosis. Second, whilst participants wished to receive a prognosis from their physiotherapist, this was often not their experience. Third, participants perceived that physiotherapists have the potential to impact prognosis through exercise prescription, management of conditions, and improving function. Fourth, receiving a prognosis can have both a positive and negative impact on the individual. Positive impacts include planning for the future, motivation, knowledge acquisition, and instilling hope. However, receiving a prognosis can be disheartening if a patient's expectations are unmet. Finally, participants have several preferences regarding receiving a prognosis including when and how often the prognosis is discussed, what prognostic information is provided, how the prognosis is presented, and what prognosis based on. CONCLUSION Individuals wish to receive a prognosis, although this is not always their experience. Individuals perceive that physiotherapists have the ability to provide a prognosis and impact their prognosis. Furthermore, receiving a prognosis has an impact on itself. To ensure patient-centred care, physiotherapists should explicitly discuss the prognosis with patients and consider their preferences when providing a prognosis.
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Affiliation(s)
- Nicholas Mullen
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
| | - Samantha Ashby
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
| | - Robin Haskins
- John Hunter Hospital Outpatient Service, Hunter New England Health, Newcastle, Australia
| | - Peter Osmotherly
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
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Ferreira GE, Zadro JR, Traeger AC, Jones CP, West CA, O'Keeffe M, Jenkins H, McAuley J, Maher CG. Adding Brief Pain Science or Ergonomics Messages to Guideline Advice Did Not Increase Feelings of Reassurance in People With Acute Low Back Pain: A Randomized Experiment. J Orthop Sports Phys Ther 2023; 53:769-779. [PMID: 37751303 DOI: 10.2519/jospt.2023.12090] [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] [Indexed: 09/27/2023]
Abstract
OBJECTIVE: To investigate the effects of adding pain science or ergonomics messages to guideline advice on feelings of reassurance and management intentions among people with acute low back pain (LBP). DESIGN: Three-arm parallel-group randomized experiment. METHODS: We recruited people with acute LBP (pain for ≤6 weeks) to participate in an online experiment. Participants were randomized at a 1:1:1 ratio to one of three groups: guideline advice alone or guideline advice with the addition of brief pain science or ergonomics messages. The intervention was delivered via prerecorded videos in all 3 groups. Coprimary outcomes were reassurance that (1) no serious condition is causing LBP and (2) continuing with daily activities is safe. Secondary outcomes were perceived risk of developing chronic pain, management intentions (bed rest, see a health professional, see a specialist, and imaging), credibility, and relevance of the advice in addressing the participant's concerns. RESULTS: Two thousand two hundred ninety-seven responses (99.3% of 2,313 randomized) were analyzed. Adding brief pain science or ergonomics messages to guideline advice did not change reassurance that LBP was not caused by serious disease. The addition of ergonomics advice provided worse reassurance that it is safe to continue with daily activities compared to guideline advice (mean difference [MD], -0.33; 95% CI: 0.13, 0.53). There was no difference between groups on management intentions. CONCLUSION: Adding pain science or ergonomics messages to guideline advice did not increase reassurance or change management intentions in people with acute LBP. Ergonomics messages may lead to reduced feelings of reassurance. J Orthop Sports Phys Ther 2023;53(12)1-11. Epub 26 September 2023. doi:10.2519/jospt.2023.12090.
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Zhou T, Salman D, McGregor AH. What do we mean by 'self-management' for chronic low back pain? A narrative review. 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 2023; 32:4377-4389. [PMID: 37640886 DOI: 10.1007/s00586-023-07900-4] [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: 03/29/2023] [Revised: 03/29/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Chronic low back pain (CLBP) is a highly prevalent musculoskeletal condition affecting 60-80% of the general population within their lifetime. Given the large numbers of people affected, self-management approaches have been introduced as a way to manage this condition with endorsement by the national institute for health and care excellence. Interventions are often termed self-management without defining either content or goals. Our study sought to determine the content, characteristics, and evidence for self-management of CLBP. METHODS This narrative review was conducted using a systematic approach to search journal articles in English that focused on CLBP self-management. MEDLINE, EMBASE, CINAHL, and PsycINFO databases were used to identify publications with terms relating to back pain and self-management from January 2016 until January 2022. RESULTS In total, 15 studies were found suitable for inclusion in the review. Core components of self-management strategies include exercise, education, and psychological interventions, but there was a lack of consistency with respect to content. Intervention characteristics were either under-reported or varied. Furthermore, outcome measures used to assess these self-management programmes were diverse, mainly focusing on functional disability and pain intensity. CONCLUSIONS Inconsistencies in the content of self-management interventions, intervention characteristics, and outcome measures used for assessing self-management programmes were found across the literature. Current self-management approaches do not consider the complex biopsychosocial nature of CLBP. A consensus on the key components of self-management interventions, and how they should be evaluated, will pave the way for research to determine whether self-management can effectively manage CLBP.
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Affiliation(s)
- Tianyu Zhou
- MSk Lab, Department of Surgery & Cancer, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
| | - David Salman
- MSk Lab, Department of Surgery & Cancer, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Alison H McGregor
- MSk Lab, Department of Surgery & Cancer, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK.
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Taik FZ, Bensaid R, Adnine A, Mansouri NE, Aharrane FZ, Amar A, Fourtassi M, Abourazzak FE. Use of social media as a source of health information among patients with chronic low back pain. Musculoskeletal Care 2023. [PMID: 38009905 DOI: 10.1002/msc.1846] [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: 11/07/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To evaluate the use of social media (SM) as a source of health information among patients with chronic low back pain (LBP) and to evaluate the factors associated with this use. METHODS This was a cross-sectional study involving patients with chronic LBP. Information on their sociodemographics, LBP characteristics, and comorbidities was collected. With the use of a questionnaire, we evaluated the use of SM as a source of information, examining the frequency of use, the type of SM used, and degree of confidence and application of information found. Catastrophising, trust in physicians, and concerns regarding medicines were assessed through the Pain Catastrophizing Scale (PCS), Trust in Physician Scale (TPS) and Beliefs about Medicines Questionnaire (BMQ Specific Concerns). A regression analysis was conducted to identify factors associated with the use of SM. RESULTS A total of 118 patients were included. The mean age was 53.01 ± 14.09 years. Of the sample, 68.6% sought information regarding their LBP on social networks. The main source was YouTube (30%). Eighteen point six percent of patients trusted the information found through SM, and 16.1% have already acted on some of this information. The majority of patients (82%) would prefer to have healthcare professionals in their virtual spaces to answer their questions. In a multivariate analysis, only the degree of trust in the physician was negatively associated with SM use (OR = 0.95 IC 95% [0.91-0.99]; p = 0.03). CONCLUSION This survey showed that a proportion of patients suffering from chronic LBP use SM, YouTube in particular, as a source of health information. The level of trust in physicians was the strongest factor that impelled people to use SM as a source of health information.
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Affiliation(s)
- Fatima Zahrae Taik
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
- Life and Health Sciences Laboratory, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Rajaa Bensaid
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
| | - Anass Adnine
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
- Life and Health Sciences Laboratory, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Noema El Mansouri
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
| | | | - Amine Amar
- Applied Mathematics and Data Science, School of Science and Engineering, Al Akhawayn University, Ifrane, Morocco
| | - Maryam Fourtassi
- Life and Health Sciences Laboratory, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
- Physical Medicine and Rehabilitation Department, Mohammed VI University Hospital, Tangier, Morocco
| | - Fatima Ezzahra Abourazzak
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
- Life and Health Sciences Laboratory, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
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Cormack B, Stilwell P, Coninx S, Gibson J. The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization. Physiother Theory Pract 2023; 39:2273-2288. [PMID: 35645164 DOI: 10.1080/09593985.2022.2080130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION There are increasing recommendations to use the biopsychosocial model (BPSM) as a guide for musculoskeletal research and practice. However, there is a wide range of interpretations and applications of the model, many of which deviate from George Engel's original BPSM. These deviations have led to confusion and suboptimal patient care. OBJECTIVES 1) To review Engel's original work; 2) outline prominent BPSM interpretations and misapplications in research and practice; and 3) present an "enactive" modernization of the BPSM. METHODS Critical narrative review in the context of musculoskeletal pain. RESULTS The BPSM has been biomedicalized, fragmented, and used in reductionist ways. Two useful versions of the BPSM have been running mostly in parallel, rarely converging. The first version is a "humanistic" interpretation based on person- and relationship-centredness. The second version is a "causation" interpretation focused on multifactorial contributors to illness and health. Recently, authors have argued that a modern enactive approach to the BPSM can accommodate both interpretations. CONCLUSION The BPSM is often conceptualized in narrow ways and only partially implemented in clinical care. We outline how an "enactive-BPS approach" to musculoskeletal care aligns with Engel's vision yet addresses theoretical limitations and may mitigate misapplications.
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Affiliation(s)
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Sabrina Coninx
- Institute for Philosophy II, Ruhr University Bochum, Bochum, Germany
| | - Jo Gibson
- Physiotherapy Department, Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
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Orlando JF, Beard M, Guerin M, Kumar S. Systematic review of predictors of hospitalisation for non-specific low back pain with or without referred leg pain. PLoS One 2023; 18:e0292648. [PMID: 37816006 PMCID: PMC10564130 DOI: 10.1371/journal.pone.0292648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
Significant costs and utilisation of healthcare resources are associated with hospitalisations for non-specific low back pain despite clinical guidelines recommending community-based care. The aim of this systematic review was to investigate the predictors of hospitalisation for low back pain. A protocol was registered with PROSPERO international prospective register of systematic reviews (#CRD42021281827) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Database search of Ovid Medline, Emcare, Embase, PsycINFO, Cochrane Library, PEDro and OTSeeker was conducted. Studies were included if they examined a predictor of hospitalisation for non-specific low back pain with or without referred leg pain. Data was extracted and descriptively synthesised. Risk of bias of included studies was assessed using the Critical Appraisal Skills Programme Checklists. There were 23 studies published over 29 articles which identified 52 predictor variables of hospitalisation for low back pain. The risk of hospitalisation was grouped into themes: personal, health and lifestyle, psychology, socioeconomic, occupational, clinical, and health systems and processes. There was moderate level evidence that arrival to an emergency department via ambulance with low back pain, and older age increase the risk of hospitalisations for low back pain. There was low level evidence that high pain intensity, past history of low back pain, opioid use, and occupation type increase the risk of hospitalisation for low back pain. Further research into psychological and social factors is warranted given the paucity of available studies. Hospital avoidance strategies, improved patient screening and resource utilisation in emergency departments are considerations for practice.
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Affiliation(s)
- Joseph F. Orlando
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, Australia
- Central Adelaide Local Health Network, Adelaide, Australia
| | - Matthew Beard
- Central Adelaide Local Health Network, Adelaide, Australia
| | - Michelle Guerin
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Saravana Kumar
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, Australia
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Lanfredini R, Cipriani L. The experience of pain and its ontological modelling from a philosophical point of view: Phenomenological description and ontological revision of the McGill Pain Questionnaire. J Eval Clin Pract 2023; 29:1211-1221. [PMID: 37358237 DOI: 10.1111/jep.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/19/2023] [Indexed: 06/27/2023]
Abstract
The aim of the article is to identify, on the basis of the phenomenological and ontological analysis of the experience of pain and the ways in which this experience is expressed in natural language, an ontological modelling of the language of pain and, at the same time, a revision of the traditional version of the McGill questionnaire. The purpose is to provide a different characterisation and an adequate evaluation of the phenomenon of pain, and, consequently, an effective measure of the actual experience of the suffering subject.
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Affiliation(s)
| | - Letizia Cipriani
- Department of Humanities, University of Florence, Florence, Italy
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Levi Y, Gottlieb U, Shavit R, Springer S. A matter of choice: Should students self-select exercise for their nonspecific chronic low back pain? A controlled study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2099-2105. [PMID: 34403329 DOI: 10.1080/07448481.2021.1960845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/21/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To explore the effect of autonomy to choose exercise-therapy (ET) for nonspecific chronic low back pain (NSCLBP) on treatment adherence and clinical outcomes. PARTICIPANTS Forty-six students were recruited from Ariel University. METHODS Every two gender-and-age-matched students were allocated to either self-selected exercise group (SSE) or pre-determined exercise group (PDE). Subjects completed 4-weeks exercise and filled a training-log. Oswestry disability-index (ODI) and numerical pain-rating scores (NPRS) were measured, as well as exercise quality-performance. RESULTS ODI and NPRS improved in both groups, with no between-group differences. Exercise quality-performance was also similar between groups. A trend for better exercise-adherence was found in the SSE-group (75.3% vs 65.0% adherence, p = 0.08, effect size d = 0.59). Meaningful NPRS improvement was demonstrated in 54.5% of SSE-group participants compared with 33.3% in the PDE-group. CONCLUSIONS Autonomy may serve as a factor to enhance treatment adherence and clinical outcomes of ET for NSCLBP among students.
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Affiliation(s)
- Yhonatan Levi
- Faculty of Health Sciences, Department of Physical Therapy, The Neuromuscular & Human Performance Laboratory, Ariel University, Ariel, Israel
| | - Uri Gottlieb
- Faculty of Health Sciences, Department of Physical Therapy, The Neuromuscular & Human Performance Laboratory, Ariel University, Ariel, Israel
| | - Ron Shavit
- Faculty of Health Sciences, Department of Physical Therapy, The Neuromuscular & Human Performance Laboratory, Ariel University, Ariel, Israel
| | - Shmuel Springer
- Faculty of Health Sciences, Department of Physical Therapy, The Neuromuscular & Human Performance Laboratory, Ariel University, Ariel, Israel
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29
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Panchal S, Hendrick P. The lived experiences of musculoskeletal physiotherapists managing patient expectations for diagnostic imaging: A qualitative study using a phenomenological analysis. Musculoskelet Sci Pract 2023; 67:102833. [PMID: 37672861 DOI: 10.1016/j.msksp.2023.102833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/29/2023] [Accepted: 07/21/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES Unnecessary diagnostic imaging for musculoskeletal presentations is a pervasive phenomenon, placing a substantial weight on healthcare resources. Their overuse can lead to iatrogenic consequences associated with overdiagnosis and overtreatment. Factors which contribute to inappropriate imaging are multifactorial. Clinician-patient beliefs, behaviours, and expectations have been identified as central drivers. Physiotherapists play an important role in the utilisation of diagnostic imaging for musculoskeletal presentations throughout healthcare settings. This study aims to explore the lived experiences of physiotherapists managing patient expectations for diagnostic imaging. DESIGN A qualitative study using an interpretative phenomenological analysis. Five participants were purposefully recruited and took part in semi-structured individual interviews. RESULTS The central themes identified were expectations for diagnostic imaging, managing expectations, communicating imaging findings, imaging as a therapeutic tool, and risk and uncertainty. CONCLUSION The findings from this study gives new insights into how musculoskeletal physiotherapists manage expectations for diagnostic imaging, the associated complexities, and the challenges encountered.
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Plener J, Mior S, Atkinson-Graham M, Hogg-Johnson S, Côté P, Ammendolia C. It might take a village: developing a rehabilitation program of care for degenerative cervical radiculopathy from the patient perspective. Disabil Rehabil 2023:1-8. [PMID: 37735902 DOI: 10.1080/09638288.2023.2256653] [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: 02/28/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE The aim of our study is to inform the development of a rehabilitation program of care from the perspectives of those suffering from degenerative cervical radiculopathy (DCR). MATERIAL AND METHODS We conducted a qualitative study, purposefully recruiting individuals with DCR. Transcripts from virtual semi-structured interviews were iteratively analyzed using interpretative phenomenological methods. RESULTS Eleven participants were recruited and depicted their ideal rehabilitation program of care. Participants described the importance of a patient centered-approach, health care providers who were validating, reassuring and attentive, easier access to health services, a supportive and collaborative team environment, and receiving peer support. Furthermore, participants expressed that they would expect the program of care to result in their symptoms being less intense and intermittent. In consideration of the participant perspectives, the ideal rehabilitation program of care can be conceptualized by the enactive-biopsychosocial model, which provides a theoretical framework for developing and implementing the program of care. CONCLUSION We obtained valuable information from individuals living with DCR regarding their preferences and expectations of a rehabilitation program of care. The participant descriptions will provide the groundwork for its development to meet patient needs and expectations. Future research to guide implementation will also be explored.
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Affiliation(s)
- Joshua Plener
- Division of Graduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
- Department of Medicine, Mount Sinai Hospital, Toronto, Canada
| | - Silvano Mior
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Institute for Disability and Rehabilitation Research, Oshawa, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Melissa Atkinson-Graham
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Institute for Disability and Rehabilitation Research, Oshawa, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Oshawa, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carlo Ammendolia
- Department of Medicine, Mount Sinai Hospital, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
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van Dijk MJH, van der Wal AM, Mollema J, Visser B, Kiers H, Heerkens Y, van der Sanden MWGN. The Observable Movement Quality scale for patients with low back pain (OMQ-LBP): validity and reliability in a primary care setting of physical therapy. BMC Musculoskelet Disord 2023; 24:705. [PMID: 37667238 PMCID: PMC10476334 DOI: 10.1186/s12891-023-06784-1] [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: 10/21/2022] [Accepted: 08/06/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The Observable Movement Quality scale for patients with low back pain (OMQ-LBP) is a newly developed measurement instrument for use in primary care settings of physical and exercise therapists to assess movement quality (MQ) of patients with low back pain (LBP). OBJECTIVE This study aims to determine validity, reliability and feasibility of the OMQ-LBP. The OMQ-LBP consists of a standardized movement circuit (performed twice) consisting of five daily activities problematic for LBP patients, which are scored with an 11-item observation list. METHODS Construct validity was determined by testing seven hypotheses on associations between constructs (n = 85 patients with LBP) and four hypotheses on known group differences (n = 85 patients with LBP and n = 63 healthy controls; n = 35 matched participant-patients having VAS-pain ≥ 20 mm during and/or after both circuits and healthy controls). Internal consistency was analyzed with Cronbach's alpha (n = 85 patients with LBP). For inter- and intra-rater reliability Intraclass Correlation Coefficient (ICC) values were examined (n = 14 therapists: seven primary care physical therapists and seven exercise therapists). Additionally, content validity and feasibility were determined using thematic analysis of a brief interview with participants, patients (n = 38) and therapists (n = 14). RESULTS After Bonferroni correction 2/7 associations between constructs and 2/4 significant group differences were confirmed. Cronbach's alpha was 0,79. The ICC-values of interrater reliability of the OMQ-LBP total score and the duration score were 0.56 and 0.99 and intra-rater reliability 0.82 and 0,93, respectively. Thematic analysis revealed five themes. Three themes elucidate that both patients and therapists perceived the content of the OMQ-LBP as valid. The fourth theme exhibits that OMQ-LBP provides a clear and unambiguous language for MQ in patients with LBP. Theme 5 depicts that the OMQ-LBP seems feasible, but video recording is time-consuming. CONCLUSIONS The OMQ-LBP is a promising standardized observational assessment of MQ during the five most problematic daily activities in patients with LBP. It is expected that uniform and objective description and evaluation of MQ add value to clinical reasoning and facilitate uniform communication with patients and colleagues.
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Affiliation(s)
- M J H van Dijk
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands.
- Radboud University Medical CenterRadboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
| | - A M van der Wal
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands
| | - J Mollema
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands
| | - B Visser
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - H Kiers
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands
| | - Y Heerkens
- Department Occupation & Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Adje M, Steinhäuser J, Laekeman M, Rogan S, Karstens S. Evaluation of a blended learning approach on stratified care for physiotherapy bachelor students. BMC MEDICAL EDUCATION 2023; 23:545. [PMID: 37525131 PMCID: PMC10391990 DOI: 10.1186/s12909-023-04517-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Stratified models of care are valuable for addressing psychosocial factors which influence the outcome of patients with musculoskeletal disorders. Introducing such models in undergraduate training has the potential to propagate this knowledge with evidence and foster its implementation. The objective of this paper is to explore the perception and changes in the fear-avoidance beliefs of physiotherapy students participating in a developed blended learning course on stratified care. METHODOLOGY A mixed-methods with a convenient sample of two consecutive cohorts were given a blended learning course on stratified care for patients with low back pain. The blended learning course comprised scientific rudiments and application of stratified care in clinical practice conceptualised using the KERN' 6-step approach. The exam scores, perceptions, performance on self-reflection-tests and pre- and post-scores on The Tampa Scale for Kinesiophobia for Physiotherapists' (TSK-PT) were obtained. After gaining clinical experience, participants were invited to discuss their clinical experiences and perceptions in workshops. The quantitative data was analysed explorative-descriptively. The qualitative data was analysed following an inductive coding system with constant comparisons. RESULTS Ninety-one participants consented to the evaluation (mean age = 22.9 ± 1.6 years), 66% were female. Exam scores correlated with time spent in training (r = 0.30) and scores on self-reflection-tests 1 and 2 (r = 0.40 and r = 0.41). Participants in both cohorts described the learning resources as promoting their interest in the subject (72% and 94%), up-to-date (91% and 93%) and helpful (91% and 97%). The fear-avoidance scores for participants decreased from 53.5 (± 9.96) to 40.1 (± 12.4) with a large effect size (d = 1.18). The regression model [F (2, 49) = 1151.2, p < 0.001] suggests that pre-TSK-PT and the interest of participants in the training predicted post-TSK-PT. The workshop participants (n = 62) all worked in clinical practice. Emerging from the analysis were 4 categories (evolving to maturity in practice, perceiving determinants of stratified care, strategising for implementation and adopting an outlook for future practice). CONCLUSION The quality of engagement in learning, training strategy and interest in the subject contributes immensely to learning outcomes. This blended learning course was successful in reducing kinesiophobia and influencing the participants' attitude towards care with the potential of being translated into long-term practice.
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Affiliation(s)
- Mishael Adje
- Therapeutic Sciences, Department of Computer Science, Trier University of Applied Sciences, Trier, Germany.
- Institute of Family Medicine, University of Luebeck, Luebeck, Germany.
| | - Jost Steinhäuser
- Institute of Family Medicine, University of Luebeck, Luebeck, Germany
| | - Marjan Laekeman
- Department of Physiological Psychology, University of Bamberg, Bochum, Germany
| | - Slavko Rogan
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Sven Karstens
- Therapeutic Sciences, Department of Computer Science, Trier University of Applied Sciences, Trier, Germany
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Bruce M, Lopatina E, Hodge J, Moffat K, Khan S, Pyle P, Kashuba S, Wasylak T, Santana MJ. Understanding the chronic pain journey and coping strategies that patients use to manage their chronic pain: a qualitative, patient-led, Canadian study. BMJ Open 2023; 13:e072048. [PMID: 37491089 PMCID: PMC10373679 DOI: 10.1136/bmjopen-2023-072048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To gain an insight into coping strategies that people living with chronic pain use to self-manage their pain. DESIGN This qualitative Patient-oriented Research study used the Patient and Community Engagement Research approach. It was conducted by people with chronic pain lived experience, ensuring that patient perspective and needs were considered and addressed throughout the research cycle. Purposeful sampling was used for recruiting individuals living with chronic pain. A focus group and one-on-one semi-structured interviews were conducted via videoconference. The data were analysed iteratively using inductive thematic analysis and narrative story analysis. SETTING Calgary, Alberta, Canada. PARTICIPANTS Eleven adult participants, between the ages of 18 and 65, who self-identified as living with chronic pain for greater than 2 years. RESULTS Three main themes emerged from the data: (1) the elements of chronic pain, (2) the chronic pain journey to acceptance and (3) daily coping strategies for chronic pain. Participants thought it was important to discuss these three themes because the daily coping strategies that they employed at any given time (theme 3) depended on the factors discussed in themes 1 and 2. Overlaying all of this is also a grieving process that people living with chronic pain may have to go through more than once. Participants also identified recommendations for healthcare professionals to support people living with chronic pain. CONCLUSIONS Dealing with chronic pain affects all aspects of a person's life and involves a grieving process. When treating patients with chronic pain, it is important for healthcare professionals to understand the journey that people living with chronic pain go through, not just coping strategies. Diagnosis is critical for a patient's acceptance and in helping them find their new normal where they can employ daily coping strategies to manage their pain.
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Affiliation(s)
- Marcia Bruce
- Department of Medicine, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
| | - Elena Lopatina
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jamie Hodge
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
- Departments of Continuing Education and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Karen Moffat
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
- Departments of Continuing Education and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sophia Khan
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
- Departments of Continuing Education and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Pamela Pyle
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
- Departments of Continuing Education and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sherri Kashuba
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Maria-Jose Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Ampiah JA, Moffatt F, Diver C, Ampiah PK. A Qualitative Investigation of the Psychosocial Impact of Chronic Low Back Pain in Ghana. BMJ Open 2023; 13:e073538. [PMID: 37474173 PMCID: PMC10360413 DOI: 10.1136/bmjopen-2023-073538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) is a global health concern associated with multidimensional/biopsychosocial levels of affectation in developed countries, with holistic management requiring consideration of these factors. There has been minimal research exploring the psychosocial impact of CLBP, and the factors influencing it, in African contexts, with none in Ghana. OBJECTIVES To explore the psychosocial impact of CLBP among patients with CLBP in Ghana. DESIGN Qualitative study using individual semistructured face-to-face interviews, underpinned by Straussian grounded theory principles and critical realist philosophy. PARTICIPANTS Thirty patients with CLBP attending physiotherapy at two hospitals in Ghana. RESULTS Five categories: loss of self and roles, emotional distress, fear, stigmatisation and marginalisation, financial burden, and social support and three mechanisms: acquired biomedical/mechanical beliefs from healthcare professionals (HCPs), sociocultural beliefs and the socioeconomic impact of CLBP were derived. CONCLUSION CLBP adversely affects multidimensional/biopsychosocial aspects of individuals experiencing CLBP in Ghana. This delineates the need for a biopsychosocial approach to care. There is the need for HCPs in Ghana to reassess current CLBP management strategies to address the influence of adverse HCPs biomedical inclinations on patients' psychosocial consequences. Population-based education strategies and consideration of formal support systems for persons with disabling CLBP may also be beneficial.
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Affiliation(s)
- Josephine Ahenkorah Ampiah
- Division of Physiotherapy, Chiropractic and Sports Rehabilitation, London South Bank University, London, UK
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Claire Diver
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Paapa Kwesi Ampiah
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
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Kondo Y, Ota R, Fujita H, Miki T, Watanabe Y, Takebayashi T. Quality of Japanese Online Information on Causes of Neck Pain: A Biopsychosocial Analysis. Cureus 2023; 15:e41353. [PMID: 37546098 PMCID: PMC10399279 DOI: 10.7759/cureus.41353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Background While a considerable amount of information on neck pain is available online, the quality and comprehensiveness of this information can vary greatly. Particularly, the representation of the biopsychosocial model - which recognizes neck pain as an interplay of biological, psychological, and social factors - in online information remains unclear. Given the prevalence and accessibility of online health information, it is important to understand its quality and how it may shape individuals' understanding and management of neck pain. Therefore, the objective of this study was to analyze the quality of online Japanese information on the causes of neck pain from a biopsychosocial perspective. Methodology A descriptive cross-sectional study was conducted. The search term "neck pain" was utilized on Google's search engine in June 2023, and the websites from the first two pages of the search results were included in the study. Ten advertisement websites were excluded, resulting in 19 websites being analyzed. Each website was evaluated based on the presence of the Health-on-the-Net (HON) code. Biomedical and psychosocial factors present in each website were identified using the biopsychosocial analysis tool. Websites were then categorized as biomedical, limited biopsychosocial, or biopsychosocial based on the number of psychosocial factors they mentioned. Results Among the 19 evaluated websites, only one possessed the HON certification, indicating a potential lack of credibility for the remaining sites. Of these websites, a large majority (63.2%) were classified as biomedical, while the remaining (36.8%) were classified as limited biopsychosocial. All the websites included some form of biomedical information on the causes of neck pain, while only seven websites mentioned psychological factors and one website mentioned social factors. The most common biomedical causes of neck pain discussed were cervical muscle strain and radicular pain due to cervical disc prolapse. On the other hand, the limited biopsychosocial websites highlighted perceived stress, depressed mood, and job-related mental stress as psychosocial factors contributing to neck pain. Conclusions This analysis revealed that freely accessible Japanese online information on the causes of neck pain, as found through Google, predominantly focuses on the biomedical causes, often neglecting or insufficiently addressing the psychosocial aspects. This finding underscores a gap between the available online resources and the comprehensive understanding promoted by the biopsychosocial model of health. Healthcare professionals need to be proactive in guiding their patients toward reliable, well-rounded resources that acknowledge the crucial role of psychosocial factors in neck pain. Furthermore, developers of online health information must aim to improve the depth and breadth of psychosocial factors discussed, promoting a more holistic understanding of neck pain for the Japanese public.
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Affiliation(s)
- Yu Kondo
- Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, JPN
| | - Rumi Ota
- Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, JPN
| | - Hisaki Fujita
- Rehabilitation, Tokachi Orthopedic Clinic, Obihiro, JPN
| | - Takahiro Miki
- Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, JPN
| | - Yuta Watanabe
- Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, JPN
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Vanderstraeten R, Fourré A, Demeure I, Demoulin C, Michielsen J, Anthierens S, Bastiaens H, Roussel N. How Do Physiotherapists Explain Influencing Factors to Chronic Low Back Pain? A Qualitative Study Using a Fictive Case of Chronic Non-Specific Low Back Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105828. [PMID: 37239555 DOI: 10.3390/ijerph20105828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND While pain is influenced by multiple factors including psychosocial factors, previous research has shown that physiotherapists still favour a biomedical approach. PURPOSE To evaluate: (1) how physiotherapists explain the patient's chronic non-specific low back pain (LBP); (2) whether physiotherapists use one or multiple influencing factors, and (3) whether these factors are framed in a biopsychosocial or biomedical approach. MATERIALS AND METHODS This exploratory qualitative study uses a vignette depicting chronic non-specific LBP and employs a flexible framework analysis. Physiotherapists were asked to mention contributing factors to the pain based on this vignette. Five themes were predefined ("Beliefs", "Previous experiences", "Emotions", "Patients behaviour", "Contextual factors") and explored. RESULTS Physiotherapists use very brief explanations when reporting contributing factors to chronic pain (median 13 words). Out of 670 physiotherapists, only 40% mentioned more than two different themes and 2/3rds did not see any link between the patients' misbeliefs and pain. Only a quarter of the participants mentioned the patient's worries about pain and movement, which is considered to be an important influencing factor. CONCLUSION The lack of a multifactorial approach and the persistent biomedical beliefs suggest that it remains a challenge for physiotherapists to fully integrate the biopsychosocial framework into their management of chronic LBP.
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Affiliation(s)
- Rob Vanderstraeten
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Antoine Fourré
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Neurosciences, Université de Mons, 7000 Mons, Belgium
| | - Isaline Demeure
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liege, EVAREVA, 4000 Liege, Belgium
- Faculty of Motricity Sciences, UCLouvain, 1348 Louvain-la-Neuve, Belgium
| | - Jozef Michielsen
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Anatomy and Research Centre (ASTARC), University Hospital of Antwerp, Antwerp Surgical Training, 2650 Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Hilde Bastiaens
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
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Naye F, Décary S, Houle C, LeBlanc A, Cook C, Dugas M, Skidmore B, Tousignant-Laflamme Y. Six Externally Validated Prognostic Models Have Potential Clinical Value to Predict Patient Health Outcomes in the Rehabilitation of Musculoskeletal Conditions: A Systematic Review. Phys Ther 2023; 103:7066982. [PMID: 37245218 DOI: 10.1093/ptj/pzad021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/21/2022] [Accepted: 01/06/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to identify and appraise externally validated prognostic models to predict a patient's health outcomes relevant to physical rehabilitation of musculoskeletal (MSK) conditions. METHODS We systematically reviewed 8 databases and reported our findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. An information specialist designed a search strategy to identify externally validated prognostic models for MSK conditions. Paired reviewers independently screened the title, abstract, and full text and conducted data extraction. We extracted characteristics of included studies (eg, country and study design), prognostic models (eg, performance measures and type of model) and predicted clinical outcomes (eg, pain and disability). We assessed the risk of bias and concerns of applicability using the prediction model risk of bias assessment tool. We proposed and used a 5-step method to determine which prognostic models were clinically valuable. RESULTS We found 4896 citations, read 300 full-text articles, and included 46 papers (37 distinct models). Prognostic models were externally validated for the spine, upper limb, lower limb conditions, and MSK trauma, injuries, and pain. All studies presented a high risk of bias. Half of the models showed low concerns for applicability. Reporting of calibration and discrimination performance measures was often lacking. We found 6 externally validated models with adequate measures, which could be deemed clinically valuable [ie, (1) STart Back Screening Tool, (2) Wallis Occupational Rehabilitation RisK model, (3) Da Silva model, (4) PICKUP model, (5) Schellingerhout rule, and (6) Keene model]. Despite having a high risk of bias, which is mostly explained by the very conservative properties of the PROBAST tool, the 6 models remain clinically relevant. CONCLUSION We found 6 externally validated prognostic models developed to predict patients' health outcomes that were clinically relevant to the physical rehabilitation of MSK conditions. IMPACT Our results provide clinicians with externally validated prognostic models to help them better predict patients' clinical outcomes and facilitate personalized treatment plans. Incorporating clinically valuable prognostic models could inherently improve the value of care provided by physical therapists.
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Affiliation(s)
- Florian Naye
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Simon Décary
- Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, Quebec, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Quebec, Quebec, Canada
| | - Catherine Houle
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, Quebec, Quebec, Canada
| | - Chad Cook
- Physical Therapy Division, Duke University, Durham, North Carolina, USA
| | - Michèle Dugas
- VITAM Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
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Rizzo RRN, Wand BM, Leake HB, O'Hagan ET, Bagg MK, Bunzli S, Traeger AC, Gustin SM, Moseley GL, Sharma S, Cashin AG, McAuley JH. "My Back is Fit for Movement": A Qualitative Study Alongside a Randomized Controlled Trial for Chronic Low Back Pain. THE JOURNAL OF PAIN 2023; 24:824-839. [PMID: 36577460 DOI: 10.1016/j.jpain.2022.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
A new wave of treatments has emerged to target nervous system alterations and maladaptive conceptualizations about pain for chronic low back pain. The acceptability of these treatments is still uncertain. We conducted a qualitative study alongside a randomized controlled trial to identify perceptions of facilitators or barriers to participation in a non-pharmacological intervention that resulted in clinically meaningful reductions across 12 months for disability compared to a sham intervention. We conducted semi-structured interviews with participants from the trial's active arm after they completed the 12-week program. We included a purposeful sample (baseline and clinical characteristics) (n = 20). We used reflexive thematic analysis informed by the Theoretical Framework of Acceptability for health care interventions. We identified positive and negative emotional/cognitive responses associated with treatment acceptability and potential efficacy, including emotional support, cognitive empowerment, readiness for self-management, and acceptance of face-to-face and online components designed to target the brain. These findings suggest the importance of psychoeducation and behavior change techniques to create a positive attitude towards movement and increase the perception of pain control; systematic approaches to monitor and target misconceptions about the interventions during treatment; and psychoeducation and behavior change techniques to maintain the improvements after the cessation of formal care. PERSPECTIVE: This article presents the experiences of people with chronic low back pain participating in a new non-pharmacological brain-targeted treatment that includes face-to-face and self-directed approaches. The facilitators and barriers of the interventions could potentially inform adaptations and optimization of treatments designed to target the brain to treat chronic low back pain.
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Affiliation(s)
- Rodrigo R N Rizzo
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia.
| | - Benedict M Wand
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Hayley B Leake
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Edel T O'Hagan
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia. Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Queensland, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Adrian C Traeger
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
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Takasaki H. Predictors of 1-Year Perceived Recovery, Absenteeism, and Expenses Due to Low Back Pain in Workers Receiving Mechanical Diagnosis and Therapy: A Prospective Cohort Study. Healthcare (Basel) 2023; 11:healthcare11091293. [PMID: 37174835 PMCID: PMC10178341 DOI: 10.3390/healthcare11091293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/22/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
This multicenter prospective cohort study aimed to preliminarily explore statistically relevant modifiable and predetermined factors for 1-year perceived recovery, absenteeism, and personal expenses in workers who received Mechanical Diagnosis and Therapy (MDT) for low back pain (LBP). Three stepwise multiple regression models were explored with 42 independent variables, including (1) socio-demographic factors; (2) risk stratification; (3) pain-related variables, psychological variables, and behavioral variables at baseline and changes after a month; (4) therapeutic alliance and exercise adherence at 1-month follow-up; and (5) MDT classification and therapist levels. Data from 58 participants were analyzed, after which a model with a medium effect size was developed for 1-year perceived recovery only. Consequently, patients with derangement syndrome were expected to have improved 1-year perceived recovery, with expected predetermined prognostic factors including shorter symptom duration, self-management skills to lead a healthy life, and less pain catastrophization at baseline. A stronger therapeutic alliance between patient and therapist during the 1-month MDT intervention was identified as an expected modifiable prognostic factor. It may be difficult to accurately predict the annual absenteeism and personal expenses due to LBP given the weak to low effect sizes of the developed models.
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Affiliation(s)
- Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya 343-8540, Japan
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40
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Nim CG, Hansen A, Backmann T, Ziegler DS, O'Neill S. Multidisciplinary team-based management approach for secondary-care patients with severe and persistent low back pain: A mixed-method feasibility trial. J Back Musculoskelet Rehabil 2023:BMR220369. [PMID: 37092217 DOI: 10.3233/bmr-220369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Persistent and severe low back pain is challenging to treat. Multidisciplinary care with systematic follow-up may be more effective than usual care. However, such a model has yet to be developed and tested. OBJECTIVE Our objectives were to develop and test the feasibility of a three-month multidisciplinary intervention with systematic follow-up in a specialized hospital spine center for patients with severe and persistent low back pain. METHODS Using the Medical Research Council and National Institute for Health and Care Research framework for the development and testing of complex interventions, we developed a multidisciplinary intervention with systematic follow-up and tested its feasibility, using a-priori-determined outcomes during three months for 24 patients seen at a regional diagnostic spine center unit. As part of the evaluation, we conducted semi-structured interviews with participants and a focus-group interview with clinicians. RESULTS Of the 24 patients included, only 17 completed the course of care and provided complete data for feasibility assessment. We failed to reach our a-priori feasibility outcomes, had difficulty with inclusion, and participants did not find the intervention effective or satisfactory. CONCLUSIONS The intervention was not feasible as barriers existed on multiple levels (e.g., clinical, administrative, and patient). Excessive study moderations must be made before the intervention is feasible in a randomized trial.
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Affiliation(s)
- Casper Glissmann Nim
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Anders Hansen
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Tina Backmann
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
| | - Dorthe Schøler Ziegler
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren O'Neill
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Sherriff B, Clark C, Killingback C, Newell D. Musculoskeletal practitioners' perceptions of contextual factors that may influence chronic low back pain outcomes: a modified Delphi study. Chiropr Man Therap 2023; 31:12. [PMID: 37020314 PMCID: PMC10075502 DOI: 10.1186/s12998-023-00482-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/03/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Optimal shaping of contextual factors (CFs) during clinical encounters may be associated with analgesic responses in treatments for musculoskeletal pain. These CFs (i.e., the patient-practitioner relationship, patient's and practitioner's beliefs/characteristics, treatment characteristics, and environment) have not been widely evaluated by musculoskeletal practitioners. Understanding their views has the potential to improve treatment quality and effectiveness. Drawing on a panel of United Kingdom practitioners' expertise, this study aimed to investigate their perceptions of CFs during the management of patients presenting with chronic low back pain (LBP). METHODS A modified two-round online Delphi-consensus survey was conducted to measure the extent of panel agreement regarding the perceived acceptability and influence of five main types of CFs during clinical management of patients with chronic LBP. Qualified musculoskeletal practitioners in the United Kingdom providing regular treatment for patients with chronic LBP were invited to take part. RESULTS The successive Delphi rounds included 39 and 23 panellists with an average of 19.9 and 21.3 years of clinical experience respectively. The panel demonstrated a high degree of consensus regarding approaches to enhance the patient-practitioner relationship (18/19 statements); leverage their own characteristics/beliefs (10/11 statements); modify the patient's beliefs and consider patient's characteristics (21/25 statements) to influence patient outcomes during chronic LBP rehabilitation. There was a lower degree of consensus regarding the influence and use of approaches related to the treatment characteristics (6/12 statements) and treatment environment (3/7 statements), and these CFs were viewed as the least important. The patient-practitioner relationship was rated as the most important CF, although the panel were not entirely confident in managing a range of patients' cognitive and emotional needs. CONCLUSION This Delphi study provides initial insights regarding a panel of musculoskeletal practitioners' attitudes towards CFs during chronic LBP rehabilitation in the United Kingdom. All five CF domains were perceived as capable of influencing patient outcomes, with the patient-practitioner relationship being perceived as the most important CF during routine clinical practice. Musculoskeletal practitioners may require further training to enhance their proficiency and confidence in applying essential psychosocial skills to address the complex needs of patients with chronic LBP.
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Affiliation(s)
- Bronwyn Sherriff
- Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, 504 Bournemouth Gateway Building, 10 St Paul's Lane, Bournemouth, Dorset, BH8 8AJ, England.
- AECC University College, Bournemouth, England.
| | - Carol Clark
- Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, 504 Bournemouth Gateway Building, 10 St Paul's Lane, Bournemouth, Dorset, BH8 8AJ, England
| | - Clare Killingback
- Department of Sport, Health and Exercise Sciences, Faculty of Health Sciences, University of Hull, Hull, England
| | - Dave Newell
- AECC University College, Bournemouth, England
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Cashin AG, Wand BM, O'Connell NE, Lee H, Rizzo RR, Bagg MK, O'Hagan E, Maher CG, Furlan AD, van Tulder MW, McAuley JH. Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2023; 4:CD013815. [PMID: 37014979 PMCID: PMC10072849 DOI: 10.1002/14651858.cd013815.pub2] [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] [Indexed: 04/06/2023]
Abstract
BACKGROUND Pharmacological interventions are the most used treatment for low back pain (LBP). Use of evidence from systematic reviews of the effects of pharmacological interventions for LBP published in the Cochrane Library, is limited by lack of a comprehensive overview. OBJECTIVES To summarise the evidence from Cochrane Reviews of the efficacy, effectiveness, and safety of systemic pharmacological interventions for adults with non-specific LBP. METHODS The Cochrane Database of Systematic Reviews was searched from inception to 3 June 2021, to identify reviews of randomised controlled trials (RCTs) that investigated systemic pharmacological interventions for adults with non-specific LBP. Two authors independently assessed eligibility, extracted data, and assessed the quality of the reviews and certainty of the evidence using the AMSTAR 2 and GRADE tools. The review focused on placebo comparisons and the main outcomes were pain intensity, function, and safety. MAIN RESULTS Seven Cochrane Reviews that included 103 studies (22,238 participants) were included. There is high confidence in the findings of five reviews, moderate confidence in one, and low confidence in the findings of another. The reviews reported data on six medicines or medicine classes: paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, benzodiazepines, opioids, and antidepressants. Three reviews included participants with acute or sub-acute LBP and five reviews included participants with chronic LBP. Acute LBP Paracetamol There was high-certainty evidence for no evidence of difference between paracetamol and placebo for reducing pain intensity (MD 0.49 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI -1.99 to 2.97), reducing disability (MD 0.05 on a 0 to 24 scale (higher scores indicate worse disability), 95% CI -0.50 to 0.60), and increasing the risk of adverse events (RR 1.07, 95% CI 0.86 to 1.33). NSAIDs There was moderate-certainty evidence for a small between-group difference favouring NSAIDs compared to placebo at reducing pain intensity (MD -7.29 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI -10.98 to -3.61), high-certainty evidence for a small between-group difference for reducing disability (MD -2.02 on a 0-24 scale (higher scores indicate worse disability), 95% CI -2.89 to -1.15), and very low-certainty evidence for no evidence of an increased risk of adverse events (RR 0.86, 95% CI 0. 63 to 1.18). Muscle relaxants and benzodiazepines There was moderate-certainty evidence for a small between-group difference favouring muscle relaxants compared to placebo for a higher chance of pain relief (RR 0.58, 95% CI 0.45 to 0.76), and higher chance of improving physical function (RR 0.55, 95% CI 0.40 to 0.77), and increased risk of adverse events (RR 1.50, 95% CI 1. 14 to 1.98). Opioids None of the included Cochrane Reviews aimed to identify evidence for acute LBP. Antidepressants No evidence was identified by the included reviews for acute LBP. Chronic LBP Paracetamol No evidence was identified by the included reviews for chronic LBP. NSAIDs There was low-certainty evidence for a small between-group difference favouring NSAIDs compared to placebo for reducing pain intensity (MD -6.97 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI -10.74 to -3.19), reducing disability (MD -0.85 on a 0-24 scale (higher scores indicate worse disability), 95% CI -1.30 to -0.40), and no evidence of an increased risk of adverse events (RR 1.04, 95% CI -0.92 to 1.17), all at intermediate-term follow-up (> 3 months and ≤ 12 months postintervention). Muscle relaxants and benzodiazepines There was low-certainty evidence for a small between-group difference favouring benzodiazepines compared to placebo for a higher chance of pain relief (RR 0.71, 95% CI 0.54 to 0.93), and low-certainty evidence for no evidence of difference between muscle relaxants and placebo in the risk of adverse events (RR 1.02, 95% CI 0.67 to 1.57). Opioids There was high-certainty evidence for a small between-group difference favouring tapentadol compared to placebo at reducing pain intensity (MD -8.00 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI -1.22 to -0.38), moderate-certainty evidence for a small between-group difference favouring strong opioids for reducing pain intensity (SMD -0.43, 95% CI -0.52 to -0.33), low-certainty evidence for a medium between-group difference favouring tramadol for reducing pain intensity (SMD -0.55, 95% CI -0.66 to -0.44) and very low-certainty evidence for a small between-group difference favouring buprenorphine for reducing pain intensity (SMD -0.41, 95% CI -0.57 to -0.26). There was moderate-certainty evidence for a small between-group difference favouring strong opioids compared to placebo for reducing disability (SMD -0.26, 95% CI -0.37 to -0.15), moderate-certainty evidence for a small between-group difference favouring tramadol for reducing disability (SMD -0.18, 95% CI -0.29 to -0.07), and low-certainty evidence for a small between-group difference favouring buprenorphine for reducing disability (SMD -0.14, 95% CI -0.53 to -0.25). There was low-certainty evidence for a small between-group difference for an increased risk of adverse events for opioids (all types) compared to placebo; nausea (RD 0.10, 95% CI 0.07 to 0.14), headaches (RD 0.03, 95% CI 0.01 to 0.05), constipation (RD 0.07, 95% CI 0.04 to 0.11), and dizziness (RD 0.08, 95% CI 0.05 to 0.11). Antidepressants There was low-certainty evidence for no evidence of difference for antidepressants (all types) compared to placebo for reducing pain intensity (SMD -0.04, 95% CI -0.25 to 0.17) and reducing disability (SMD -0.06, 95% CI -0.40 to 0.29). AUTHORS' CONCLUSIONS We found no high- or moderate-certainty evidence that any investigated pharmacological intervention provided a large or medium effect on pain intensity for acute or chronic LBP compared to placebo. For acute LBP, we found moderate-certainty evidence that NSAIDs and muscle relaxants may provide a small effect on pain, and high-certainty evidence for no evidence of difference between paracetamol and placebo. For safety, we found very low- and high-certainty evidence for no evidence of difference with NSAIDs and paracetamol compared to placebo for the risk of adverse events, and moderate-certainty evidence that muscle relaxants may increase the risk of adverse events. For chronic LBP, we found low-certainty evidence that NSAIDs and very low- to high-certainty evidence that opioids may provide a small effect on pain. For safety, we found low-certainty evidence for no evidence of difference between NSAIDs and placebo for the risk of adverse events, and low-certainty evidence that opioids may increase the risk of adverse events.
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Affiliation(s)
- Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Rodrigo Rn Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
- New College Village, University of New South Wales, Sydney, Australia
| | - Edel O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Christopher G Maher
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | | | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
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Wewege MA, Bagg MK, Jones MD, Ferraro MC, Cashin AG, Rizzo RR, Leake HB, Hagstrom AD, Sharma S, McLachlan AJ, Maher CG, Day R, Wand BM, O'Connell NE, Nikolakopolou A, Schabrun S, Gustin SM, McAuley JH. Comparative effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain: systematic review and network meta-analysis. BMJ 2023; 380:e072962. [PMID: 36948512 PMCID: PMC10540836 DOI: 10.1136/bmj-2022-072962] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To evaluate the comparative effectiveness and safety of analgesic medicines for acute non-specific low back pain. DESIGN Systematic review and network meta-analysis. DATA SOURCES Medline, PubMed, Embase, CINAHL, CENTRAL, ClinicalTrials.gov, clinicialtrialsregister.eu, and World Health Organization's International Clinical Trials Registry Platform from database inception to 20 February 2022. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials of analgesic medicines (eg, non-steroidal anti-inflammatory drugs, paracetamol, opioids, anti-convulsant drugs, skeletal muscle relaxants, or corticosteroids) compared with another analgesic medicine, placebo, or no treatment. Adults (≥18 years) who reported acute non-specific low back pain (for less than six weeks). DATA EXTRACTION AND SYNTHESIS Primary outcomes were low back pain intensity (0-100 scale) at end of treatment and safety (number of participants who reported any adverse event during treatment). Secondary outcomes were low back specific function, serious adverse events, and discontinuation from treatment. Two reviewers independently identified studies, extracted data, and assessed risk of bias. A random effects network meta-analysis was done and confidence was evaluated by the Confidence in Network Meta-Analysis method. RESULTS 98 randomised controlled trials (15 134 participants, 49% women) included 69 different medicines or combinations. Low or very low confidence was noted in evidence for reduced pain intensity after treatment with tolperisone (mean difference -26.1 (95% confidence intervals -34.0 to -18.2)), aceclofenac plus tizanidine (-26.1 (-38.5 to -13.6)), pregabalin (-24.7 (-34.6 to -14.7)), and 14 other medicines compared with placebo. Low or very low confidence was noted for no difference between the effects of several of these medicines. Increased adverse events had moderate to very low confidence with tramadol (risk ratio 2.6 (95% confidence interval 1.5 to 4.5)), paracetamol plus sustained release tramadol (2.4 (1.5 to 3.8)), baclofen (2.3 (1.5 to 3.4)), and paracetamol plus tramadol (2.1 (1.3 to 3.4)) compared with placebo. These medicines could increase the risk of adverse events compared with other medicines with moderate to low confidence. Moderate to low confidence was also noted for secondary outcomes and secondary analysis of medicine classes. CONCLUSIONS The comparative effectiveness and safety of analgesic medicines for acute non-specific low back pain are uncertain. Until higher quality randomised controlled trials of head-to-head comparisons are published, clinicians and patients are recommended to take a cautious approach to manage acute non-specific low back pain with analgesic medicines. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019145257.
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Affiliation(s)
- Michael A Wewege
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Michael C Ferraro
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Rodrigo Rn Rizzo
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Hayley B Leake
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Amanda D Hagstrom
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Gadigal Country, Sydney, NSW, Australia
| | - Christopher G Maher
- Sydney Musculoskeletal Health, University of Sydney, Gadigal Country, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Richard Day
- Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
- St Vincent's Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Benedict M Wand
- Faculty of Medicine, Nursing and Midwifery and Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
| | - Adriani Nikolakopolou
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Centre, University of Freiburg, Freiburg, Germany
| | - Siobhan Schabrun
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Physical Therapy, University of Western Ontario, London, ON, Canada
- The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON, Canada
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
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Gorgon E, Maka K, Sullivan J, Nisbet G, Hancock M, Regan G, Leaver A. Redesigning care for back pain in an Australian hospital setting: A service evaluation to identify need for change. Musculoskeletal Care 2023; 21:232-243. [PMID: 36069172 DOI: 10.1002/msc.1695] [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: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This needs assessment study examined current processes of physiotherapy care for adults with back pain in a large teaching hospital serving a multicultural community in Sydney, Australia. Evaluation of current practices is a necessary first step in the design of a patient-centred, multidisciplinary service that promotes best practice in back pain management. METHODS We conducted a retrospective service evaluation in the physiotherapy outpatient department by reviewing clinical data on episode of care and processes of care for adults managed for back pain over a 6-month period using a defined protocol (n = 252). RESULTS Patients (median age = 56 years; 72.2% born outside of Australia) were referred from various internal and external sources, with 79.8% having chronic back pain. The median length of episode of care was 8 weeks. Active interventions were almost universally used (98.4% of records). Key aspects of assessment were frequently recorded (84.5%-98% of records), but psychosocial risk assessment was not routinely recorded. Aspects of longitudinal management planning, including goal setting, outcome measurement, and routine follow-up, were also not routinely recorded. CONCLUSIONS This study demonstrated that physiotherapy processes of care in this setting followed key messages of best practice particularly with regard to interventions, in contrast to other settings and jurisdictions. However, the brief episodes of care and less evident focus on psychosocial aspects might not align with the needs of the majority with chronic back pain. These findings suggest the need to reframe processes of care with a biopsychosocial approach and structure episodes of care towards long-term management solutions.
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Affiliation(s)
- Edward Gorgon
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Physical Therapy, University of the Philippines Manila, Manila, Philippines
| | - Katherine Maka
- Western Sydney Local Health District, New South Wales Health, Sydney, New South Wales, Australia
| | - Justin Sullivan
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gillian Nisbet
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Hancock
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gerard Regan
- Western Sydney Local Health District, New South Wales Health, Sydney, New South Wales, Australia
| | - Andrew Leaver
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Lee HJ, Cho HE, Kim M, Chung SY, Park JH. Validity and Reliability of a Non-Radiographic Postural Analysis Device Based on an RGB-Depth Camera Comparing EOS 3D Imaging: A Prospective Observational Study. Healthcare (Basel) 2023; 11:healthcare11050686. [PMID: 36900692 PMCID: PMC10000598 DOI: 10.3390/healthcare11050686] [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: 01/05/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
The posture-analyzing and virtual reconstructing device (PAViR) used a Red Green Blue-Depth camera as a sensor and skeleton reconstruction images were produced. This PAViR quickly analyzed the whole posture from multiple repetitive shots without radiation exposure in clothes and provided a virtual skeleton within seconds. This study aims to evaluate the reliability when shooting repeatedly and to assess the validity compared to parameters of full-body, low-dose X-rays (EOSs) when applied as diagnostic imaging. As a prospective and observational study, 100 patients with musculoskeletal pain underwent an EOS to obtain whole body coronal and sagittal images. The outcome measures were human posture parameters, which were divided by the standing plane in both EOSs and PAViRs as follows: (1) a coronal view (asymmetric clavicle height, pelvic oblique, bilateral Q angles of the knee, and center of seventh cervical vertebra-central sacral line (C7-CSL)) and (2) a sagittal view (forward head posture). A validation of the PAViR compared to the EOSs revealed that C7-CSL showed a moderate positive correlation with that of the EOS (r = 0.42, p < 0.01). The forward head posture (r = 0.39, p < 0.01), asymmetric clavicle height (r = 0.37, p < 0.01), and pelvic oblique (r = 0.32, p < 0.01) compared to those of the EOS had slightly positive correlations. The PAViR has excellent intra-rater reliability in people with somatic dysfunction. Except for both Q angles, the PAViR has fair-to-moderate validation when compared to EOS diagnostic imaging in the parameter representing coronal and sagittal imbalance. Although the PAViR system is not yet available in the medical field, it has the potential to become a radiation-free, accessible, and cost-effective postural analysis diagnostic tool after the EOS era.
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Affiliation(s)
- Hyo Jeong Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng Hospital, Seongnam-si 13590, Gyeonggi-do, Republic of Korea
| | - Han Eol Cho
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul 06229, Republic of Korea
| | - Myungsang Kim
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul 06229, Republic of Korea
| | - Seok Young Chung
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul 06229, Republic of Korea
| | - Jung Hyun Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul 06229, Republic of Korea
- Department of Integrative Medicine, Yonsei University College of Medicine, Seoul 06229, Republic of Korea
- Department of Medical Device Engineering and Management, Yonsei University College of Medicine, Seoul 06229, Republic of Korea
- Correspondence: ; Tel.: +82-2-2019-3490
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Monk C, Sole G, Perry M. Physiotherapists' attitudes and beliefs about self-management as part of their management for low back pain. Musculoskelet Sci Pract 2023; 64:102727. [PMID: 36804721 DOI: 10.1016/j.msksp.2023.102727] [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: 11/17/2022] [Revised: 01/18/2023] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Perceptually, there is a discrepancy between research evidence and clinical physiotherapy practice for supporting self-management in people with low back pain (LBP). OBJECTIVE This study aimed to explore physiotherapists' understanding of LBP; ascertain their knowledge of self-management concepts; and explore their attitudes and beliefs about supporting self-management for LBP within present physiotherapy practice in private and hospital settings. DESIGN Interpretive Description qualitative methodology, involving in-depth data interpretation to clinical practice, was used. METHODS Semi-structured interviews with physiotherapists throughout New Zealand were conducted via video conferencing. Data was analysed and themes were defined. RESULTS Seventeen physiotherapists (24-65 years old), with between one and 40+ years of experience, participated. Four main themes were defined: 1) Evolving understanding of LBP, 2) apportioning responsibility, 3) self-management is important, 4) understanding self-management. CONCLUSION Novel findings from this research demonstrate examples of attitudes and beliefs that determine when and how self-management for people with LBP is implemented. Due to these attitudes and beliefs, physiotherapists may not consistently provide supported self-management for people with LBP. Participants had good understanding of LBP but lacked a contemporary knowledge of the natural history and tended to apportion responsibility for persistent or recurrent episodes to the person with LBP. Physiotherapists should be encouraged to assimilate more contemporary research evidence into their expectations of recovery for LBP. Further education about the role of physiotherapists in supporting self-management, the core components of self-management, including engagement, and reflection upon individual unconscious bias should be encouraged.
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Affiliation(s)
- Celia Monk
- School of Physiotherapy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Gisela Sole
- School of Physiotherapy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Meredith Perry
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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Adje M, Steinhäuser J, Stevenson K, Mbada C, Alonge V, Karstens S. Developing tailored intervention strategies for implementation of stratified care to low back pain with physiotherapists in Nigeria: a Delphi study. BMC Health Serv Res 2023; 23:134. [PMID: 36759830 PMCID: PMC9909884 DOI: 10.1186/s12913-023-09123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Stratified care approach involving use of the STarT-Back tool to optimise care for patients with low back pain is gaining widespread attention in western countries. However, adoption and implementation of this approach in low-and-middle-income countries will be restricted by context-specific factors that need to be addressed. This study aimed to develop with physiotherapists, tailored intervention strategies for the implementation of stratified care for patients with low back pain. METHODS A two-round web-based Delphi survey was conducted among purposively sampled physiotherapists with a minimum of three years of clinical experience, with post-graduation certification or specialists. Thirty statements on barriers and enablers for implementation were extracted from the qualitative phase. Statements were rated by a Delphi panel with additional open-ended feedback. After each Delphi round, participants received feedback which informed their subsequent responses. Additional qualitative feedback were analysed using qualitative content analysis. The criteria for consensus and stability were pre-determined using percentage agreement (≥ 75%), median value (≥ 4), Inter-quartile range (≤ 1), and Wilcoxon matched-pairs test respectively. RESULTS Participants in the first round were 139 and 125 of them completed the study, yielding a response rate of 90%. Participants were aged 35.2 (SD6.6) years, and 55 (39.6%) were female. Consensus was achieved in 25/30 statements. Wilcoxon's test showed stability in responses after the 5 statements failed to reach consensus: 'translate the STarT-Back Tool to pidgin language' 71% (p = 0.76), 'begin implementation with government hospitals' 63% (p = 0.11), 'share knowledge with traditional bone setters' 35% (p = 0.67), 'get second opinion on clinician's advice' 63% (p = 0.24) and 'carry out online consultations' 65% (p = 0.41). Four statements strengthened by additional qualitative data achieved the highest consensus: 'patient education' (96%), 'quality improvement appraisals' (96%), 'undergraduate training on psychosocial care' (96%) and 'patient-clinician communication' (95%). CONCLUSION There was concordance of opinion that patients should be educated to correct misplaced expectations and proper time for communication is vital to implementation. This communication should be learned at undergraduate level, and for already qualified clinicians, quality improvement appraisals are key to sustained and effective care. These recommendations provide a framework for future research on monitored implementation of stratified care in middle-income countries.
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Affiliation(s)
- Mishael Adje
- Therapeutic Sciences, Trier University of Applied Sciences, Trier, Germany. .,Institute of Family Medicine, University of Luebeck, Luebeck, Germany.
| | - Jost Steinhäuser
- grid.4562.50000 0001 0057 2672Institute of Family Medicine, University of Luebeck, Luebeck, Germany
| | - Kay Stevenson
- grid.9757.c0000 0004 0415 6205The Impact Accelerator Unit, The Medical School Keele University, Keele, United Kingdom
| | - Chidozie Mbada
- grid.25627.340000 0001 0790 5329Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Victor Alonge
- Department of Physiotherapy, Exercise and Sports, LUNEX International University of Health, Differdange, Luxembourg
| | - Sven Karstens
- grid.434099.30000 0001 0475 0480Therapeutic Sciences, Department of Computer Science, Trier University of Applied Sciences, Trier, Germany
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Effect of integrated exercise therapy and psychosocial interventions on self-efficacy in patients with chronic low back pain: A systematic review. J Psychosom Res 2023; 165:111126. [PMID: 36610335 DOI: 10.1016/j.jpsychores.2022.111126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/17/2022] [Accepted: 12/19/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Investigate if integrated exercise and psychosocial (EP) interventions effect self-efficacy to manage pain and self-efficacy for physical functioning compared to alternate interventions, usual care, waitlists and attention controls for individuals with chronic low back pain (CLBP). METHODS MEDLINE, Embase, CINAHL, Web of Science, PsychINFO, PEDro, and Cochrane Library were searched. Included randomized controlled trials utilized an EP intervention for CLBP and measured self-efficacy. Independent reviewers screened abstracts, reviewed full-texts, extracted data, and assessed risk of bias. GRADE, synthesis without meta-analysis, and ranges of effects (Hedges' g) were used. RESULTS 2207 Participants were included (22-studies). EP interventions positively effected self-efficacy to manage pain short-term compared to usual care (range of effects: -0.02, 0.94) and controls (range of effects: 0.69, 0.80) and intermediately compared to usual care (range of effects: 0.11, 0.29); however, no differences were found when compared to alternate interventions. EP interventions positively effected self-efficacy for physical functioning short-term compared to alternate interventions (range of effects: 0.57, 0.71), usual care (range of effects: -0.15, 0.94), and controls (range of effects: 0.31, 0.56), and intermediately compared to alternate interventions (1-study, effect: 0.57) and controls (1-study, effect: 0.56). Conclusions were limited by low to very low-quality-evidence often from risk of bias, imprecision, and clinical/statistical heterogeneity. CONCLUSIONS EP interventions may be more effective short-term for self-efficacy to manage pain than usual care and waitlists, but not alternate interventions. EP interventions may be effective for self-efficacy for physical functioning at short- and intermediate-term compared to alternate interventions, usual care, waitlist and attention controls. Considerations for future research include methods for blinding and measurement of self-efficacy for physical functioning.
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Corrêa LA, Bittencourt JV, Mathieson S, Nogueira LAC. Pain-related interference and pain-related psychosocial factors of three different subgroups of patients with chronic low back pain. Musculoskelet Sci Pract 2023; 63:102718. [PMID: 36641362 DOI: 10.1016/j.msksp.2023.102718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Low back pain (LBP) subgroup identification and management are a research priority. The clarification of subgroup differences could assist clinicians in clinical decisions contributing to a tailored treatment. OBJECTIVES To compare pain-related interference and pain-related psychosocial factors among subgroups of chronic low back pain (localised low back pain, peripheral neuropathic back pain, and widespread pain). DESIGN Cross-sectional study. METHODS A cross-sectional study was conducted on 444 participants with chronic low back pain. Pain-related interference was investigated by the Brief Pain Inventory and Patient-Specific Functional Scale. Pain-related psychosocial factors assessment included psychosocial factors from Brief Screening Questions and maladaptive beliefs from Back Beliefs Questionnaire, self-efficacy, and expectation questions. Participants' characteristics, pain-related interference, and pain-related psychosocial factors were compared among the three groups. RESULTS A one-way ANCOVA presented statistically significant differences among the groups for current pain intensity [F(2,441) = 6.77, p = 0.001], pain duration [F(2,425) = 9.83, p < 0.001], pain-related interference by Brief Pain Inventory [F(2,441) = 11.97, p < 0.001], and pain-related psychosocial factors regarding symptoms of anxiety [F(2,441) = 3.85, p = 0.022], symptoms of depression [F(2,441) = 6.74, p = 0.001], social isolation [F(2,441) = 6.54, p = 0.002], catastrophising [F(2,441) = 9.72, p < 0.001], perceived stress [F(2,441) = 3.93, p = 0.020], maladaptive beliefs [F(2,441) = 6.89, p = 0.001], and expectation [F(2,441) = 6.66, p = 0.001]. CONCLUSION Participants with widespread pain presented higher pain-related interference and pain-related psychosocial factors compared to the localised low back pain group. Participants with peripheral neuropathic back pain and widespread pain presented with similar characteristics.
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Affiliation(s)
- Leticia Amaral Corrêa
- Rehabilitation Science Postgraduation Program - Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil.
| | - Juliana Valentim Bittencourt
- Rehabilitation Science Postgraduation Program - Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Stephanie Mathieson
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduation Program - Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil; Physiotherapy Department - Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
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O'Hagan ET, Cashin AG, Traeger AC, McAuley JH. Person-centred education and advice for people with low back pain: Making the best of what we know. Braz J Phys Ther 2023; 27:100478. [PMID: 36657216 PMCID: PMC9868342 DOI: 10.1016/j.bjpt.2022.100478] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The first-line treatment consistently recommended for people with low back pain is patient education and advice. Regardless of the duration of low back pain, clinicians should provide education on the benign nature of low back pain, reassurance about the absence of a serious medical condition, and advice to remain active. There is little guidance on how best to provide this care. OBJECTIVE This Masterclass will draw on recent evidence to explore how physical therapy clinicians could deliver person-centred education and advice to people with low back pain to refine their clinical consultation. DISCUSSION First, we highlight the potential value of providing validation to acknowledge the distressing experience and consequences of low back pain. Second, we describe a tool to open channels of communication to provide education and advice in a patient-centred and efficient way. Clinicians could consider using the Attitude toward Education and advice for Low back pain Questionnaire to gain an insight into patient attitudes toward education and advice at the outset of a clinical encounter. Finally, we provide options for tailoring patient education and advice to promote self-management of low back pain based on patient attitudes. We present evidence that a positive attitude toward messages about causes rather than messages about physical activity predicts intention to self-manage low back pain. We combine this evidence to suggest a pathway for clinicians to provide education and advice to people with low back pain within the time constraints of a clinical consultation.
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Affiliation(s)
- Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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