Individual advice in addition to standard guideline care in patients with acute non-specific low back pain: A survey on feasibility among physiotherapists and patients

"Myths and Facts" Education Is Comparable to "Facts Only" for Recall of Back Pain Information but May Improve Fear-Avoidance Beliefs: An Embedded Randomized Trial

OBJECTIVE

To assess the effectiveness of patient education with "myths and facts" versus "facts only" on recall of back pain information and fear-avoidance beliefs in patients with chronic low back pain (LBP).

DESIGN

Randomized Study Within A Trial.

METHODS

One hundred fifty-two participants with chronic LBP were included. Participants allocated to the "facts only" group received an information sheet with 6 LBP facts, whereas those allocated to the "myths and facts" group received the same information sheet, with each myth refuted by its respective fact. The primary outcome was a correct recall of back pain facts, and the secondary outcome was the physical activity component of the Fear-Avoidance Beliefs Questionnaire (FABQ-PA), 2 weeks after the provision of the information sheet.

RESULTS

There was no evidence of a difference in the proportion of participants with a correct recall between the "myths and facts" and "facts only" groups (odds ratio = 0.98; 95% confidence interval [CI]: 0.48, 1.99) and no significant difference in FABQ-PA mean scores between groups (-1.58; 95% CI: -3.77, 0.61). Sensitivity analyses adjusted for prognostic factors showed no difference in information recall but a larger difference in FABQ-PA scores (-2.3; 95% CI: -4.56, -0.04).

CONCLUSION

We found no overall difference in the recall of back pain information for patients provided with "myths and facts" compared with that for patients provided with "facts only" and a slight reduction in fear-avoidance beliefs for physical activity using "myths and facts" compared with that using "facts only," but the meaningfulness of this result is uncertain. J Orthop Sports Phys Ther 2022;52(9):586-594. Epub: 9 July 2022. doi:10.2519/jospt.2022.10989.

Do patients with acute low back pain in emergency departments have more severe symptoms than those in general practice? A systematic review with meta-analysis

INTRODUCTION

There is a common belief that patients presenting to emergency departments have more severe pain levels and functional limitations than those in general practice. The aim of this systematic review was to compare pain and disability levels of patients with acute low back pain presenting to general practice versus those presenting to emergency departments.

METHODS

Electronic searches were conducted in MEDLINE, EMBASE and CINAHL from inception to February 2019. Observational studies including patients with acute non-specific low back pain presenting to emergency departments and/or general practice were eligible. Pain and/or disability scores expressed on a 0-100 scale were the primary outcomes. Risk of bias was evaluated using a validated tool for observational studies and the overall quality of evidence was assessed using GRADE. Meta-analysis using random effects and meta-regression were used to test for differences between the two settings.

RESULTS

We included 12 records reporting results for 10 unique studies with a total of 6,999 participants from general practice (n = 6) and emergency departments (n = 4). There was low quality evidence (downgraded for indirectness and inconsistency) that patients presenting to emergency departments had higher pain scores than those in general practice with a mean difference of 17.3 points (95%CI: 8.8 to 25.9 on a 0-100 scale). Similarly, there was low quality evidence (downgraded for indirectness and inconsistency) that patients presenting to emergency departments had higher disability scores than those in general practice (mean difference: 21.7, 95%CI: 4.6 to 38.7 on a 0-100 scale).

CONCLUSION

Patients with acute non-specific low back pain presenting to emergency departments may report higher levels of pain and disability than those seen in general practice.

PROSPERO REGISTRATION NUMBER

CRD42017076806.

Manual material handling advice and assistive devices for preventing and treating back pain in workers

BACKGROUND

Training and the provision of assistive devices are considered major interventions to prevent back pain and its related disability among workers exposed to manual material handling (MMH).

OBJECTIVES

To determine the effectiveness of MMH advice and training and the provision of assistive devices in preventing and treating back pain.

SEARCH STRATEGY

We searched CENTRAL (The Cochrane Library 2011, issue 1), MEDLINE, EMBASE, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT to February 2011.

SELECTION CRITERIA

We included randomised controlled trials (RCT) and cohort studies with a concurrent control group that were aimed at changing human behaviour in MMH and measured back pain, back pain-related disability or sickness absence.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted the data and assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group for RCTs and MINORS for the cohort studies.We based the results and conclusions on the analysis of RCTs only. We compared these with the results from cohort studies.

MAIN RESULTS

We included nine RCTs (20,101 employees) and nine cohort studies (1280 employees) on the prevention of back pain in this updated review. Studies compared training to no intervention (4), professional education (2), a video (3), use of a back belt (3) or exercise (2). Other studies compared training plus lifting aids to no intervention (3) and to training only (1). The intensity of training ranged from a single educational session to very extensive personal biofeedback.Six RCTs had a high risk of bias.None of the included studies showed evidence of a preventive effect of training on back pain.There was moderate quality evidence from seven RCTs (19,317 employees) that those who received training reported levels of back pain similar to those who received no intervention, with an odds ratio of 1.17 (95% confidence intervals (CI) 0.68 to 2.02) or minor advice (video), with a relative risk of 0.93 (95% CI 0.69 to 1.25). Confidence intervals around the effect estimates were still wide due to the adjustment for the design effect of clustered studies.The results of the cohort studies were similar to those of the randomised studies.

AUTHORS' CONCLUSIONS

There is moderate quality evidence that MMH advice and training with or without assistive devices does not prevent back pain or back pain-related disability when compared to no intervention or alternative interventions. There is no evidence available from RCTs for the effectiveness of MMH advice and training or MMH assistive devices for treating back pain. More high quality studies could further reduce the remaining uncertainty.