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Jain M, Khan S, Varghese P, Tripathy SK, Mangaraj M. Botulinum toxin type A for treating chronic low back pain: A double blinded randomized control study. World J Methodol 2024; 14:93854. [DOI: 10.5662/wjm.v14.i3.93854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/23/2024] [Accepted: 05/11/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is a prevalent issue that orthopedic surgeons frequently address in the outpatient setting. LBP can arise from various causes, with stiffness in the paraspinal muscles being a notable contributor. The administration of Botulinum toxin type A (BoNT-A) has been found to alleviate back pain by relaxing these stiff muscles. While BoNT-A is approved for use in numerous conditions, a limited number of randomized clinical trials (RCTs) validate its efficacy specifically for treating LBP.
AIM To study the safety and the efficacy of BoNT-A in minimizing pain and improving functional outcomes in patients of chronic LBP (CLBP).
METHODS In this RCT, adults aged 18-60 years with mechanical LBP persisting for at least six months were enrolled. Participants were allocated to either the Drug group, receiving 200 Ipsen Units (2 mL) of BoNT-A, or the Control group, which received a 2 mL placebo. Over a 2-month follow-up period, both groups were assessed using the Visual Analog Scale (VAS) for pain intensity and the Oswestry Disability Index (ODI) for disability at the start and conclusion of the study. A decrease in pain by 50% was deemed clinically significant.
RESULTS The study followed 40 patients for two months, with 20 in each group. A clinically significant reduction in pain was observed in 36 participants. There was a statistically significant decrease in both VAS and ODI scores in the groups at the end of two months. Nonetheless, when comparing the mean score changes, only the reduction in ODI scores (15 in the placebo group vs 16.5 in the drug group, clinically insignificant) was statistically significant (P = 0.012), whereas the change in mean VAS scores was not significant (P = 0.45).
CONCLUSION The study concludes that BoNT-A does not offer a short-term advantage over placebo in reducing pain or improving LBP scores in CLBP patients.
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Affiliation(s)
- Mantu Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
| | - Shahnawaz Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
| | - Paulson Varghese
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
| | - Sujit Kumar Tripathy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
| | - Manaswini Mangaraj
- Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
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Verwoerd MJ, Wittink H, Maissan F, Teunis M, van Kuijk SMJ, Smeets RJEM. Development and internal validation of a multivariable prognostic model to predict chronic pain after a new episode of non-specific idiopathic, non-traumatic neck pain in physiotherapy primary care practice. BMJ Open 2024; 14:e086683. [PMID: 39182932 DOI: 10.1136/bmjopen-2024-086683] [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: 08/27/2024] Open
Abstract
OBJECTIVE To develop and internally validate a prognostic model to predict chronic pain after a new episode of acute or subacute non-specific idiopathic, non-traumatic neck pain in patients presenting to physiotherapy primary care, emphasising modifiable biomedical, psychological and social factors. DESIGN A prospective cohort study with a 6-month follow-up between January 2020 and March 2023. SETTING 30 physiotherapy primary care practices. PARTICIPANTS Patients with a new presentation of non-specific idiopathic, non-traumatic neck pain, with a duration lasting no longer than 12 weeks from onset. BASELINE MEASURES Candidate prognostic variables collected from participants included age and sex, neck pain symptoms, work-related factors, general factors, psychological and behavioural factors and the remaining factors: therapeutic relation and healthcare provider attitude. OUTCOME MEASURES Pain intensity at 6 weeks, 3 months and 6 months on a Numeric Pain Rating Scale (NPRS) after inclusion. An NPRS score of ≥3 at each time point was used to define chronic neck pain. RESULTS 62 (10%) of the 603 participants developed chronic neck pain. The prognostic factors in the final model were sex, pain intensity, reported pain in different body regions, headache since and before the neck pain, posture during work, employment status, illness beliefs about pain identity and recovery, treatment beliefs, distress and self-efficacy. The model demonstrated an optimism-corrected area under the curve of 0.83 and a corrected R2 of 0.24. Calibration was deemed acceptable to good, as indicated by the calibration curve. The Hosmer-Lemeshow test yielded a p-value of 0.7167, indicating a good model fit. CONCLUSION This model has the potential to obtain a valid prognosis for developing chronic pain after a new episode of acute and subacute non-specific idiopathic, non-traumatic neck pain. It includes mostly potentially modifiable factors for physiotherapy practice. External validation of this model is recommended.
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Affiliation(s)
- Martine J Verwoerd
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Harriët Wittink
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Francois Maissan
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Marc Teunis
- Research Group Innovative Testing in Life Sciences and Chemistry, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessments, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- CIR Clinics in Rehabilitation, CIR, Eindhoven, The Netherlands
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Najem C, Wijma AJ, Meeus M, Cagnie B, Ayoubi F, Van Oosterwijck J, De Meulemeester K, Van Wilgen CP. "It is something you live with, like an organ in your body" a qualitative study on the lived experiences of people suffering from chronic low back pain in Lebanon. Disabil Rehabil 2024:1-12. [PMID: 39087694 DOI: 10.1080/09638288.2024.2384620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE This paper aims to understand the distinctive biopsychosocial aspects and patient perspectives on chronic low back pain in Lebanon, an Arab country with a unique and rich cultural heritage. METHOD Qualitative, semi-structured interviews with 12 Lebanese patients purposefully sampled from various governorates. The interviews included participants from different geographic areas and religions. The data underwent analysis through an inductive thematic approach guided by a bounded relativist ontology, a subjectivist epistemology, and a descriptive phenomenological framework. The coding process was managed by computer-assisted qualitative data analysis software (QSR NVivo version 12.0). RESULTS The researchers identified and constructed two themes: (1) Chronic low back pain: understanding the impact, coping strategies, and communication patterns in lived experiences within the Lebanese context. This theme sheds light on the complexities of pain management and societal influences in Lebanon. (2) Explanatory model of patients living with chronic low back pain in Lebanon. This theme allowed an exploration of the multifaceted narratives of chronic low back pain. CONCLUSION This study found that Lebanese individuals attribute chronic low back pain to biomedical factors despite some recognizing psychosocial elements. It emphasizes the need to educate patients on the biopsychosocial model, facilitate better care, and dispel misconceptions.
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Affiliation(s)
- Charbel Najem
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- L3S, Faculty of Public Health, Antonine University, Baabda, Lebanon
- Pain in Motion International Research Group, www.paininmotion.be, Brussels, Belgium
| | - A J Wijma
- Pain in Motion International Research Group, www.paininmotion.be, Brussels, Belgium
- Transcare Transdisciplinary Pain Management Center, Groningen, The Netherlands
- PAIN - VUB Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - M Meeus
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, www.paininmotion.be, Brussels, Belgium
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - B Cagnie
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - F Ayoubi
- L3S, Faculty of Public Health, Antonine University, Baabda, Lebanon
- Department of Physiotherapy, Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - J Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, www.paininmotion.be, Brussels, Belgium
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Research Foundation - Flanders (FWO), Brussels, Belgium
| | - K De Meulemeester
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, www.paininmotion.be, Brussels, Belgium
| | - C P Van Wilgen
- Pain in Motion International Research Group, www.paininmotion.be, Brussels, Belgium
- Transcare Transdisciplinary Pain Management Center, Groningen, The Netherlands
- PAIN - VUB Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
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Mihlberg E, Arnbak BAM. Prognostic factors for long-term improvement in pain and disability among patients with persistent low back pain. Chiropr Man Therap 2024; 32:26. [PMID: 38918850 PMCID: PMC11202371 DOI: 10.1186/s12998-024-00546-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: 12/12/2023] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Prognostic research in low back pain (LBP) is essential for understanding and managing the condition. This study aimed to, (1) describe the proportions with mild-moderate and severe pain and disability at baseline, 1-year and 4-year follow-up, and (2) investigate prognostic factors for improvement in pain and disability over 4 years in a cohort of secondary care LBP patients. METHODS This was a secondary analysis of a cohort of patients with LBP aged 18-40 years recruited from a non-surgical outpatient spine clinic between March 2011 and October 2013 (n = 1037). Questionnaires were collected at baseline, 1-year, and 4-year follow-up. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ 0-100) and pain intensity using the Numeric Rating Scale (NRS 0-10). 'Mild-moderate pain' was defined as NRS < 7 and 'severe pain' as NRS ≥ 7. Likewise, 'mild-moderate disability' was defined as RMDQ < 58.3, and 'severe disability' was RMDQ ≥ 58.3. In the prognostic analysis, improvement in pain and disability over 4 years was defined as meeting both criteria: decrease of ≥ 2 on the NRS and of ≥ 20.8 on the RMDQ. Sixteen candidate prognostic factors were assessed by multivariate logistic regression. RESULTS Among patients with information available at all three time points (n = 241), 54%/48% had persistent mild-moderate pain/disability, while only 7%/15% had persistent severe pain/disability. Of patients included in the multivariate prognostic analysis regarding improvement over 4 years (n = 498), 32% had improved in pain and disability after 4 years. Positive associations were found for pain intensity (OR 1.34 [95%CI: 1.17-1.54]), disability (OR 1.01 [1.00-1.02]), and regular employment or studying (OR 1.67 [1.06-2.64]), and negative associations for episode duration (OR 0.99 [0.99-1.00]) and risk of persistent pain (OR 0.58 [0.38-0.88]). CONCLUSION Patients with persistent LBP in secondary care had mostly mild-moderate pain and disability consistently at all three time points, with few having consistently severe symptoms over 4 years. Moreover, approximately half of the included patients improved in pain and disability. We found that pain intensity, disability, episode duration, regular employment or studying, and risk of persistent pain predicted a long-term improvement. However, the limited availability of complete follow-up data may affect generalisability.
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Affiliation(s)
- Elin Mihlberg
- Center of Muscle and Joint health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, DK-5230, Denmark
| | - Bodil Al-Mashhadi Arnbak
- Center of Muscle and Joint health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, DK-5230, Denmark.
- Department of Radiology, Hospital Lillebaelt, Beriderbakken 4, Vejle, DK-7100, Denmark.
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Turci AM, Spavieri JHP, Lima TCD, Silva APD, Cristofolletti A, Chaves TC. Which Scale to Assess Pain Self-efficacy Shows Better Measurement Properties in Chronic Low Back Pain? A Head-To-Head Comparison Study. Arch Phys Med Rehabil 2024:S0003-9993(24)01003-7. [PMID: 38763345 DOI: 10.1016/j.apmr.2024.05.014] [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: 09/12/2023] [Revised: 04/12/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE To compare the quality of the measurement properties of Pain Self-Efficacy Questionnaire (PSEQ)-10, PSEQ-4, PSEQ-2, Chronic Pain Self-Efficacy Scale (CPSS) long-form, and CPSS short-form (CPSS-SF) in patients with chronic low back pain (CLBP). DESIGN Cross-sectional and longitudinal studies (measurement properties). SETTING Outpatient rehabilitation. PARTICIPANTS Participants (N=245) with nonspecific CLBP (18-60y, 63% women) were enrolled in this study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pain self-efficacy questionnaires were administered on 3 occasions: baseline assessment, 1 week after the first assessment (reliability), and after an 8-week exercise program (responsiveness). The intraclass correlation coefficient (ICC) and Cronbach α were used to assess reliability and internal consistency, respectively. Pearson correlation and confirmatory factor analyses were used to assess construct validity. The area under the curve and hypothesis testing were used to assess responsiveness. RESULTS No difference was observed for all the questionnaires regarding internal consistency (Cronbach α>.7), criterion validity (r>.88), and reliability (ICC>.7). The scales confirmed >75% of the hypotheses for the construct validity, except for CPSS-SF. PSEQ-2 did not meet the criterion for structural validity. PSEQ-10 met all the criteria for good measurement properties according to Consensus-Based Standards for the Selection of Health Measurement Instruments. CONCLUSIONS It was not possible to calculate structural validity for PSEQ-2, CPSS-SF did not meet the criterion for suitable hypothesis testing for construct validity, and all the questionnaires did not show suitable measurement error, except for the PSEQ-10. Hence, the PSEQ-10 was the unique scale that met all the criteria for good measurement properties for assessing pain self-efficacy in CLBP.
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Affiliation(s)
- Aline Mendonça Turci
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo; Laboratory of Research on Movement and Pain (LabMovePain), Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo
| | - Juliana Homem Padilha Spavieri
- Laboratory of Research on Movement and Pain (LabMovePain), Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo; Department of Physical Therapy, University Federal of São Carlos, São Paulo, Brazil
| | - Thamiris Costa de Lima
- Laboratory of Research on Movement and Pain (LabMovePain), Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo; Department of Physical Therapy, University Federal of São Carlos, São Paulo, Brazil
| | - Alexsander Pereira da Silva
- Laboratory of Research on Movement and Pain (LabMovePain), Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo
| | - Amanda Cristofolletti
- Laboratory of Research on Movement and Pain (LabMovePain), Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo
| | - Thais Cristina Chaves
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo; Laboratory of Research on Movement and Pain (LabMovePain), Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo; Department of Physical Therapy, University Federal of São Carlos, São Paulo, Brazil.
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Barbe MF, Chen FL, Loomis RH, Harris MY, Kim BM, Xie K, Hilliard BA, McGonagle ER, Bailey TD, Gares RP, Van Der Bas M, Kalicharan BA, Holt-Bright L, Stone LS, Hodges PW, Klyne DM. Characterization of pain-related behaviors in a rat model of acute-to-chronic low back pain: single vs. multi-level disc injury. FRONTIERS IN PAIN RESEARCH 2024; 5:1394017. [PMID: 38770243 PMCID: PMC11102983 DOI: 10.3389/fpain.2024.1394017] [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: 03/08/2024] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Low back pain is the most common type of chronic pain. We examined pain-related behaviors across 18 weeks in rats that received injury to one or two lumbar intervertebral discs (IVD) to determine if multi-level disc injuries enhance/prolong pain. Methods Twenty-three Sprague-Dawley adult female rats were used: 8 received disc puncture (DP) of one lumbar IVD (L5/6, DP-1); 8 received DP of two lumbar IVDs (L4/5 & L5/6, DP-2); 8 underwent sham surgery. Results DP-2 rats showed local (low back) sensitivity to pressure at 6- and 12-weeks post-injury, and remote sensitivity to pressure (upper thighs) at 12- and 18-weeks and touch (hind paws) at 6, 12 and 18-weeks. DP-1 rats showed local and remote pressure sensitivity at 12-weeks only (and no tactile sensitivity), relative to Sham DP rats. Both DP groups showed reduced distance traveled during gait testing over multiple weeks, compared to pre-injury; only DP-2 rats showed reduced distance relative to Sham DP rats at 12-weeks. DP-2 rats displayed reduced positive interactions with a novel adult female rat at 3-weeks and hesitation and freezing during gait assays from 6-weeks onwards. At study end (18-weeks), radiological and histological analyses revealed reduced disc height and degeneration of punctured IVDs. Serum BDNF and TNFα levels were higher at 18-weeks in DP-2 rats, relative to Sham DP rats, and levels correlated positively with remote sensitivity in hind paws (tactile) and thighs (pressure). Discussion Thus, multi-level disc injuries resulted in earlier, prolonged and greater discomfort locally and remotely, than single-level disc injury. BDNF and TNFα may have contributing roles.
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Affiliation(s)
- Mary F. Barbe
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Frank Liu Chen
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Regina H. Loomis
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Michele Y. Harris
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Brandon M. Kim
- Medical Doctor Program, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Kevin Xie
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Brendan A. Hilliard
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Elizabeth R. McGonagle
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Taylor D. Bailey
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Ryan P. Gares
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Megan Van Der Bas
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Betsy A. Kalicharan
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Lewis Holt-Bright
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Laura S. Stone
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, United States
| | - Paul W. Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - David M. Klyne
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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Jenkins LC, Chang WJ, Humburg P, Wasinger VC, Stone LS, Dorsey SG, Renn C, Starkweather A, Schabrun SM. Sex Differences in the Serum Proteomic Profile During Acute Low Back Pain-A Preliminary Study of the Relationship to Future Low Back Pain. THE JOURNAL OF PAIN 2024; 25:104426. [PMID: 37989405 DOI: 10.1016/j.jpain.2023.11.009] [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: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
The molecular processes driving the transition from acute to chronic low back pain (LBP) remain poorly understood and are likely to be sexually dimorphic. This study aimed to explore sex differences in the serum proteomic profile of people experiencing an acute LBP episode and determine if serum protein concentrations were associated with three-month outcome. Serum samples were collected through venepuncture from 30 female and 29 male participants experiencing an acute LBP episode. Serum samples underwent trypsin digestion and fractionation using hydrophobic interaction chromatography and were then analysed using mass-spectrometry. Mass-spectrometry spectra were searched in the Swissprot database for protein identification. Sex differences in protein abundance changes were evident upon inspection of fold changes. Multivariable data analysis identified 21 serum proteins during the acute episode that correctly classified 93% of males and 23 serum proteins that correctly classified 90% of females with ongoing LBP at 3 months. Pathway analysis suggested the differentially expressed proteins during acute LBP were frequently involved in immune, inflammatory, complement, or coagulation responses. This data provides preliminary evidence that biological processes during an acute LBP episode may contribute to the resolution, or persistence, of LBP symptoms at 3 months, however, these processes differ between males and females. PERSPECTIVE: Differential expression of serum proteins was observed between male and female participants during an acute LBP episode. This preliminary work provides a foundation for future research targeting distinct immune system processes in males and females that may interfere with the transition from acute to chronic LBP.
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Affiliation(s)
- Luke C Jenkins
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Wei-Ju Chang
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Health Sciences, College of Medicine, Health and Wellbeing, University of Newcastle, New South Wales, Australia
| | - Peter Humburg
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; Mark Wainwright Analytical Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Valerie C Wasinger
- Bioanalytical Mass Spectrometry Facility, Mark Wainwright Analytical Centre, UNSW, Kensington, NSW, Australia; School of Medical Science, UNSW, Kensington, NSW, Australia
| | - Laura S Stone
- Department of Anesthesiology, Faculty of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Susan G Dorsey
- Department of Pain & Translational Symptom Science, University of Maryland Baltimore, Baltimore
| | - Cynthia Renn
- Department of Pain & Translational Symptom Science, University of Maryland Baltimore, Baltimore
| | - Angela Starkweather
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida
| | - Siobhan M Schabrun
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; The Gray Centre for Mobility and Activity, Parkwood Institute, London, Ontario, Canada; School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Harrisson SA, Ogollah R, Dunn KM, Foster NE, Konstantinou K. Prognosis of Patients With Neuropathic Low Back-Related Leg Pain: An Exploratory Study Using Prospective Data From UK Primary Care. THE JOURNAL OF PAIN 2024; 25:533-544. [PMID: 37778405 DOI: 10.1016/j.jpain.2023.09.016] [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: 03/06/2023] [Revised: 09/07/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
This prospective cohort study investigates the prognosis of patients with neuropathic low back-related leg pain consulting in UK primary care. Data from 511 patients were collected using standardised baseline clinical examinations (including magnetic resonance imaging scan findings), self-report questionnaires at baseline, 4 months, 12 months, and 3 years. Cases of possible neuropathic pain (NP) and persistent-NP were identified using either of 2 definitions: 1) clinical diagnosis of sciatica, 2) self-report version of leeds assessment for neurological symptoms and signs (s-LANSS). Mixed-effects models compared pain intensity (highest of mean leg or mean back pain [0-10 Numerical Rating Scale]) over 3-years between persistent-NP versus non-persistent-NP based on 1) clinical diagnosis, 2) s-LANSS. Logistic regression examined associations between potential prognostic factors and persistent-NP at 4 months based on the 2 NP definitions. At 4-months, using both definitions: 1) approximately 4 out of 10 patients had persistent-NP, 2) mean pain intensity was higher for patients with persistent-NP at all follow-up points compared to those without, 3) only pain self-efficacy was significantly associated with persistent-NP (s-LANSS: OR .98, sciatica: .98), but it did not predict cases of persistent-NP in either multivariable model. Based on factors routinely collected from self-report and clinical examination, it was not possible to predict persistent-NP in this population. PERSPECTIVE: This study provides evidence that neuropathic back-related leg pain in patients consulting in primary care is not always persistent. Patients with persistent neuropathic pain had worse outcomes than those without. Neither leg pain intensity, pain self-efficacy nor MRI scan findings predicted cases of persistent neuropathic pain in this patient population.
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Affiliation(s)
- Sarah A Harrisson
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK; North Staffordshire and Stoke-on-Trent Integrated Musculoskeletal Service (NIMS), Midlands Partnership University NHS Foundation Trust, Staffordshire, UK
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, UK
| | - Kate M Dunn
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK; Surgical, Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Australia
| | - Kika Konstantinou
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK; North Staffordshire and Stoke-on-Trent Integrated Musculoskeletal Service (NIMS), Midlands Partnership University NHS Foundation Trust, Staffordshire, UK
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Paschali M, Lazaridou A, Sadora J, Papianou L, Garland EL, Zgierska AE, Edwards RR. Mindfulness-based Interventions for Chronic Low Back Pain: A Systematic Review and Meta-analysis. Clin J Pain 2024; 40:105-113. [PMID: 37942696 DOI: 10.1097/ajp.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE This systematic review aimed to compile existing evidence examining the effects of mindfulness-based interventions (MBIs) for chronic low back pain (CLBP). CLBP leads to millions of disabled individuals in the United States each year. Current pharmacologic treatments are only modestly effective and may present long-term safety issues. MBIs, which have an excellent safety profile, have been shown in prior studies to be effective in treating CLBP yet remained underutilized. DESIGN Ovid/Medline, PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs), pilot RCTs, and single-arm studies that explored the effectiveness of MBIs in CLBP. METHODS Separate searches were conducted to identify trials that evaluated MBIs in reducing pain intensity in individuals with CLBP. A meta-analysis was then performed using R v3.2.2, Metafor package v 1.9-7. RESULTS Eighteen studies used validated patient-reported pain outcome measures and were therefore included in the meta-analysis. The MBIs included mindfulness meditation, mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness-oriented recovery enhancement, acceptance and commitment therapy, dialectical behavioral therapy, meditation-cognitive behavioral therapy, mindfulness-based care for chronic pain, self-compassion course, and loving-kindness course. Pain intensity scores were reported using a numerical rating scale (0 to 10) or an equivalent scale. The meta-analysis revealed that MBIs have a beneficial effect on pain intensity with a large-sized effect in adults with CLBP. CONCLUSIONS MBIs seem to be beneficial in reducing pain intensity. Although these results were informative, findings should be carefully interpreted due to the limited data the high variability in study methodologies, small sample sizes, inclusion of studies with high risk of bias, and reliance on pre-post treatment differences with no attention to maintenance of effects. More large-scale RCTs are needed to provide reliable effect size estimates for MBIs in persons with CLBP.
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Affiliation(s)
- Myrella Paschali
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
| | - Asimina Lazaridou
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
- Fielding Graduate University, Santa Barbara, CA
| | | | - Lauren Papianou
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development
- College of Social Work, University of Utah, Salt Lake City, UT
| | - Aleksandra E Zgierska
- Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, PA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
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Stubbs C, McAuliffe S, Chimenti RL, Coombes BK, Haines T, Heales L, de Vos RJ, Lehman G, Mallows A, Michner LA, Millar NL, O'Neill S, O'Sullivan K, Plinsinga M, Rathleff M, Rio E, Ross M, Roy JS, Silbernagel KG, Thomson A, Trevail T, van den Akker-Scheek I, Vicenzino B, Vlaeyen JWS, Pinto RZ, Malliaras P. Which Psychological and Psychosocial Constructs Are Important to Measure in Future Tendinopathy Clinical Trials? A Modified International Delphi Study With Expert Clinician/Researchers and People With Tendinopathy. J Orthop Sports Phys Ther 2024; 54:14-25. [PMID: 37729020 DOI: 10.2519/jospt.2023.11903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE: To identify which psychological and psychosocial constructs to include in a core outcome set to guide future clinical trials in the tendinopathy field. DESIGN: Modified International Delphi study. METHODS: In 3 online Delphi rounds, we presented 35 psychological and psychosocial constructs to an international panel of 38 clinician/researchers and people with tendinopathy. Using a 9-point Likert scale (1 = not important to include, 9 = critical to include), consensus for construct inclusion required ≥70% of respondents rating "extremely critical to include" (score ≥7) and ≤15% rating "not important to include" (score ≤3). Consensus for exclusion required ≥70% of respondents rating "not important to include" (score ≤3) and ≤15% of rating "critical to include" (score ≥7). RESULTS: Thirty-six participants (95% of 38) completed round 1, 90% (n = 34) completed round 2, and 87% (n = 33) completed round 3. Four constructs were deemed important to include as part of a core outcome set: kinesiophobia (82%, median: 8, interquartile range [IQR]: 1.0), pain beliefs (76%, median: -7, IQR: 1.0), pain-related self-efficacy (71%, median: 7, IQR: 2.0), and fear-avoidance beliefs (73%, median: -7, IQR: 1.0). Six constructs were deemed not important to include: perceived injustice (82%), individual attitudes of family members (74%), social isolation and loneliness (73%), job satisfaction (73%), coping (70%), and educational attainment (70%). Clinician/researchers and people with tendinopathy reached consensus that kinesiophobia, pain beliefs, pain self-efficacy, and fear-avoidance beliefs were important psychological constructs to measure in tendinopathy clinical trials. J Orthop Sports Phys Ther 2024;54(1):1-12. Epub 20 September 2023. doi:10.2519/jospt.2023.11903.
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11
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Allen NE, Romaliiska O, Naisby J. Pain and the Non-Pharmacological Management of Pain in People with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:S65-S80. [PMID: 38457146 PMCID: PMC11380256 DOI: 10.3233/jpd-230227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Pain is a distressing and universal experience, yet everyone's pain experience is influenced by a complex array of biological, psychological, and social factors. For people with Parkinson's disease (PwP), these biopsychosocial factors include neurodegeneration and the psychological and social factors that accompany living with a chronic, neurodegenerative condition in addition to the factors experienced by those in the general population (e.g., living with co-morbidities such as osteoarthritis). The way these factors influence each individual is likely to determine which pain management strategies are optimal for them. This review first describes pain and the biopsychosocial model of pain. It explores how pain is classified in Parkinson's disease (PD) and describes the three main types of pain: nociceptive, neuropathic, and nociplastic pain. This background provides context for a discussion of non-pharmacological pain management strategies that may aid in the management of pain in PwP; exercise, psychological strategies, acupuncture and massage. While there is little PD-specific research to inform the non-pharmacological management of pain, findings from current PD research are combined with that from chronic pain research to present recommendations for clinical practice. Recommendations include assessment that incorporates potential biopsychosocial contributors to pain that will then guide a holistic, multi-modal approach to management. As exercise provides overall benefits for PwP, those with chronic pain should be carefully monitored with exercise prescribed and adjusted accordingly. Research is needed to develop and evaluate multi-modal approaches to pain management that are delivered in a biopsychosocial framework.
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Affiliation(s)
- Natalie Elizabeth Allen
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Oksana Romaliiska
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jenni Naisby
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
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12
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Mountain DC, Ali SM, Ghio D, McDonagh JE, Cordingley L, Lee RR. Beliefs About Pain in Pediatric Inflammatory and Noninflammatory Chronic Musculoskeletal Conditions: A Scoping Review. J Pediatr Psychol 2023; 48:825-841. [PMID: 37738667 PMCID: PMC10588974 DOI: 10.1093/jpepsy/jsad046] [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: 02/16/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE The Common Sense Self-Regulatory Model posits that beliefs about pain influence coping behaviors and subsequent physical and mental health outcomes in children/young people with chronic musculoskeletal conditions. It was unclear how and what beliefs had been investigated in this population, and whether there were similarities and differences in beliefs held about pain by those experiencing inflammatory versus noninflammatory musculoskeletal conditions. This scoping review addressed this gap. METHODS A systematic search was conducted using four databases (MEDLINE, PsycINFO, Embase, and CINAHL) in November 2021. Primary studies exploring key stakeholders' (including children, parents, and/or healthcare professionals) beliefs about pain underlying pediatric chronic musculoskeletal conditions were synthesized. RESULTS Eighteen articles were identified. Cross-sectional designs were predominantly used to explore beliefs (n = 6). The majority used questionnaires to assess beliefs (n = 12). Beliefs common across musculoskeletal conditions were that children/young people felt their pain was not understood by others, and pain affected their physical functioning. Differences included children/young people and parents thinking they had some ability to control pain, and causal beliefs relating to underlying disease activity. These pain beliefs were more likely to be held in relation to inflammatory diagnoses. In contrast, children/young people and parents were more likely to view pain as uncontrollable, with more uncertainty regarding underlying causes, relating to noninflammatory diagnoses. CONCLUSIONS Methods used to explore pain beliefs were inconsistent. Studies identified similarities and differences which appear to be closely related to the underlying diagnosis. Findings justify further exploration to identify potentially modifiable targets to improve pain outcomes in this population.
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Affiliation(s)
- Danielle C Mountain
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester Academic Health Science Centre, UK
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, UK
| | - Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- Division of Informatics, Imaging and Data Sciences, Centre for Health Informatics, Manchester Academic Health Sciences Centre, University of Manchester, UK
| | - Daniela Ghio
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, UK
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester Academic Health Science Centre, UK
| | - Lis Cordingley
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester Academic Health Science Centre, UK
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, UK
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester Academic Health Science Centre, UK
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, UK
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. Construct validity of movement-evoked pain operational definitions in older adults with chronic low back pain. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:985-992. [PMID: 36944266 PMCID: PMC10391587 DOI: 10.1093/pm/pnad034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Movement-evoked pain (MeP) may predispose the geriatric chronic low back pain (LBP) population to health decline. As there are differing operational definitions for MeP, the question remains as to whether these different definitions have similar associations with health outcomes in older adults with chronic LBP. DESIGN Cross-sectional analysis of an observational study. SETTING Clinical research laboratory. SUBJECTS 226 older adults with chronic LBP. METHODS This secondary analysis used baseline data from a prospective cohort study (n = 250). LBP intensity was collected before and after the repeated chair rise test, stair climbing test, and 6-minute walk test; MeP change scores (ie, sum of pretest pain subtracted from posttest pain) and aggregated posttest pain (ie, sum of posttest pain) variables were calculated. LBP-related disability and self-efficacy were measured by the Quebec Back Pain Disability Scale (QBPDS) and Low Back Activity Confidence Scale (LOBACS), respectively. Physical function was measured with the Health ABC Performance Battery. Robust regression with HC3 standard errors was used to evaluate adjusted associations between both MeP variables and disability, self-efficacy, and physical function. RESULTS Greater aggregated posttest MeP was independently associated with worse disability (b = 0.593, t = 2.913, P = .004), self-efficacy (b = -0.870, t = -3.110, P = .002), and physical function (b = -0.017, t = -2.007, P = .039). MeP change scores were not associated with any outcome (all P > .050). CONCLUSIONS Aggregate posttest MeP was linked to poorer health outcomes in older adults with chronic LBP, but MeP change scores were not. Future studies should consider that the construct validity of MeP paradigms partially depends on the chosen operational definition.
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Affiliation(s)
- Patrick J Knox
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Corey B Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, NC 27710, United States
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE 19713, United States
- Biostatistics Core, University of Delaware, Newark, DE 19713, United States
| | - Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Jaclyn M Sions
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
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14
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Foubert A, Cleenders E, Sligchers M, Heystee L, Meeus M, Vaes P, Nijs J, Roussel NA. Associations between psychological factors, pressure pain thresholds and conditioned pain modulation and disability in (sub)-acute low back pain: a three-month follow-up study. J Man Manip Ther 2023; 31:270-278. [PMID: 36756672 PMCID: PMC10324441 DOI: 10.1080/10669817.2023.2174484] [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: 10/18/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The clinical presentation and pain experience of patients with (sub)-acute low back pain ((S)ALBP) can strongly vary in clinical practice. However, despite growing evidence that psychological factors are associated with disability in chronic pain conditions including low back pain, studies examining the influence of psychological factors, quantitative sensory testing (QST) (i.e. pressure pain thresholds (PPTs)) and conditioned pain modulation (CPM) on future disability are still lacking in (S)ALBP. OBJECTIVE This prospective cohort study aims to determine associations between baseline psychological factors, PPTs and CPM in (S)ALBP and disability after 3 months. METHODS Fifty-two patients with (S)ALBP underwent a baseline PPT evaluation in rest and during a CPM protocol. Patients were asked to fill in self-report questionnaires: the Visual Analogue Scale (VAS), the Quebec Back Pain Disability Scale (QBPDS), the Pain Catastrophizing Scale (PCS), the Tampa Scale for Kinesiophobia (TSK) and the Illness Perception Questionnaire - Brief version (IPQ-B). At 3-month follow-up, participants were asked to fill in the QBPDS again. Multiple linear regression analysis was conducted to determine associations between baseline factors and disability at follow-up. RESULTS Thirty-eight patients participated at follow-up. Because of the multicollinearity issue, the TSK score was selected for analyses and the PCS and IPQ-B score were excluded from the model. No significant associations between baseline factors and disability at follow-up were found. CONCLUSION Neither baseline psychological factors nor PPTs or CPM in (S)ALBP were significantly associated with disability after 3 months. Our multiple linear regression analysis was likely underpowered to detect significant associations.
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Affiliation(s)
- Anthe Foubert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Faculté des Sciences de la Motricité, Université catholique de Louvain, Louvain-La-Neuve, Belgium
- Pain in Motion, International Research Group, Antwerp, Belgium
| | - Evert Cleenders
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Marijke Sligchers
- Pain in Motion, International Research Group, Antwerp, Belgium
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lisette Heystee
- Pain in Motion, International Research Group, Antwerp, Belgium
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion, International Research Group, Antwerp, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Peter Vaes
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion, International Research Group, Antwerp, Belgium
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden, University of Gothenburg Center for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nathalie A. Roussel
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. Movement-Evoked Pain Versus Widespread Pain: A Longitudinal Comparison in Older Adults With Chronic Low Back Pain From the Delaware Spine Studies. THE JOURNAL OF PAIN 2023; 24:980-990. [PMID: 36706887 PMCID: PMC10257757 DOI: 10.1016/j.jpain.2023.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
It is currently unknown which pain-related factors contribute to long-term disability and poorer perceived health among older adults with chronic low back pain (LBP). This investigation sought to examine the unique influence of movement-evoked pain (MeP) and widespread pain (WP) on longitudinal health outcomes (ie, gait speed, perceived disability, and self-efficacy) in 250 older adults with chronic LBP. MeP was elicited with 3 standardized functional tests, while presence of WP was derived from the McGill Pain Map. Robust regression with HC3 standard errors was used to examine associations between these baseline pain variables and health outcomes at 12-month follow-up. Covariates for these models included age, sex, body mass index, resting and recall LBP intensity, LBP duration, depression, pain catastrophizing, and baseline outcome (eg, baseline gait speed). Greater MeP was independently associated with worse 12-month LBP-related disability (b = .384, t = 2.013, P = .046) and poorer self-efficacy (b = -.562, t = -2.074, P = .039); but not gait speed (P > .05). In contrast, WP and resting and recall LBP intensity were not associated with any prospective health outcome after adjustment (all P > .05). Compared to WP and resting and recall LBP intensity, MeP is most strongly related to longitudinal health outcomes in older adults with chronic LBP. PERSPECTIVE: This article establishes novel independent associations between MeP and worse perceived disability and self-efficacy at 12-months in older adults with chronic LBP. MeP likely has biopsychosocial underpinnings and consequences and may therefore be an important determinant of health outcomes in LBP and other geriatric chronic pain populations.
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Affiliation(s)
- Patrick J Knox
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Corey B Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, North Carolina
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, Delaware; Biostatistics Core, University of Delaware, Newark, Delaware
| | - Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Jaclyn M Sions
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, Delaware.
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Mo KC, Gupta A, Movsik J, Covarrubius O, Greenberg M, Riley LH, Kebaish KM, Neuman BJ, Skolasky RL. Pain Self-Efficacy (PSEQ) score of <22 is associated with daily opioid use, back pain, disability, and PROMIS scores in patients presenting for spine surgery. Spine J 2023; 23:723-730. [PMID: 37100496 PMCID: PMC10154031 DOI: 10.1016/j.spinee.2022.12.015] [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: 06/03/2022] [Revised: 11/14/2022] [Accepted: 12/15/2022] [Indexed: 04/28/2023]
Abstract
BACKGROUND CONTEXT Pain self-efficacy, or the belief that one can carry out activities despite pain, has been shown to be associated with back and neck pain severity. However, the literature correlating psychosocial factors to opioid use, barriers to proper opioid use, and Patient-Reported Outcome Measurement Information System (PROMIS) scores is sparse. PURPOSE The primary aim of this study was to determine whether pain self-efficacy is associated with daily opioid use in patients presenting for spine surgery. The secondary aim was to determine whether there exists a threshold self-efficacy score that is predictive of daily preoperative opioid use and subsequently to correlate this threshold score with opioid beliefs, disability, resilience, patient activation, and PROMIS scores. PATIENT SAMPLE Five hundred seventy-eight elective spine surgery patients (286 females; mean age of 55 years) from a single institution were included in this study. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. OUTCOME MEASURES PROMIS scores, daily opioid use, opioid beliefs, disability, patient activation, resilience. METHODS Elective spine surgery patients at a single institution completed questionnaires preoperatively. Pain self-efficacy was measured by the Pain Self-Efficacy Questionnaire (PSEQ). Threshold linear regression with Bayesian information criteria was utilized to identify the optimal threshold associated with daily opioid use. Multivariable analysis controlled for age, sex, education, income, and Oswestry Disability Index (ODI) and PROMIS-29, version 2 scores. RESULTS Of 578 patients, 100 (17.3%) reported daily opioid use. Threshold regression identified a PSEQ cutoff score of <22 as predictive of daily opioid use. On multivariable logistic regression, patients with a PSEQ score <22 had two times greater odds of being daily opioid users than those with a score ≥22. Further, PSEQ <22 was associated with lower patient activation; increased leg and back pain; higher ODI; higher PROMIS pain, fatigue, depression, and sleep scores; and lower PROMIS physical function and social satisfaction scores (p<.05 for all). CONCLUSIONS In patients presenting for elective spine surgery, a PSEQ score of <22 is associated with twice the odds of reporting daily opioid use. Further, this threshold is associated with greater pain, disability, fatigue, and depression. A PSEQ score <22 can identify patients at high risk for daily opioid use and can guide targeted rehabilitation to optimize postoperative quality of life.
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Affiliation(s)
- Kevin C Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Arjun Gupta
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan Movsik
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Oscar Covarrubius
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Marc Greenberg
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Lee H Riley
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
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Vigdal ØN, Storheim K, Killingmo RM, Småstuen MC, Grotle M. The one-year clinical course of back-related disability and the prognostic value of comorbidity among older adults with back pain in primary care. Pain 2023; 164:e207-e216. [PMID: 36083174 DOI: 10.1097/j.pain.0000000000002779] [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: 03/08/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Back pain and comorbidity are common in older adults. Comorbidity is a promising prognostic factor for the clinical course of back-related disability, but confirmatory studies assessing its prognostic value are needed. Thus, the aims of this study were to describe the clinical course of back-related disability during 1-year follow-up in patients aged ≥55 years visiting primary care (general practitioner, physiotherapist, or chiropractor) with a new episode of back pain and assess the prognostic value of comorbidity on back-related disability during 1-year follow-up. A prospective cohort study was conducted, including 452 patients. The outcome measure was Roland-Morris Disability Questionnaire (RMDQ, range 0-24) measured at baseline and at 3-, 6-, and 12-month follow-up. The Self-Administered Comorbidity Questionnaire was used to assess comorbidity count (CC, range 0-15) and comorbidity burden (CB, range 0-45). The RMDQ scores improved from median (interquartile range) 9 (4-13) at baseline to 4 (1-9), 4 (0-9), and 3 (0-9) at 3, 6, and 12 months, respectively. Using linear mixed-effects models, we found that CC and CB were independently associated with RMDQ scores. A 1-point increase in CC was associated with an increase in RMDQ score of 0.76 points (95% confidence interval [0.48-1.04]) over the follow-up year, adjusted for known prognostic factors. A 1-point increase in CB was associated with an increased RMDQ score of 0.47 points (95% confidence interval [0.33-0.61]). In conclusion, the clinical course of back-related disability for older adults presenting in primary care was favorable, and increased comorbidity was an independent prognostic factor for increased disability levels.
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Affiliation(s)
- Ørjan Nesse Vigdal
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Kjersti Storheim
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Rikke Munk Killingmo
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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18
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Reply to Manhapra. Pain 2023; 164:e175. [PMID: 36779561 DOI: 10.1097/j.pain.0000000000002833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Gomes LA, Rodrigues AM, Branco JC, Canhão H, Cruz EB. Clinical courses, impact and prognostic indicators for a persistent course of low back pain: Results from a population-based cohort study. PLoS One 2023; 18:e0265104. [PMID: 36930625 PMCID: PMC10022778 DOI: 10.1371/journal.pone.0265104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a long-term health condition with distinct clinical courses. Its characterization together with the identification of prognostic factors for a persistent LBP course may trigger the development of personalized interventions. This study aimed to investigate the courses of chronic LBP (CLBP), its cumulative impact, and the indicators for the persistence of pain. MATERIAL AND METHODS Patients with active CLBP from the EpiDoC, a population-based cohort study of a randomly recruited sample of 10.661 adults with prolonged follow-up, were considered. Pain, disability, and health-related quality of life (HRQoL) were assessed at three time-points over five years. According to their pain symptoms over time, participants were classified as having a persistent (pain at the baseline and at all the subsequent time-points) or a relapsing pain course (pain at the baseline and no pain at least in one of the subsequent time-points). A mixed ANOVA was used to compare mean differences within and between patients of distinct courses. Prognostic indicators for the persistent LBP course were modulated through logistic regression. RESULTS Among the 1.201 adults with active CLBP at baseline, 634 (52.8%) completed the three time-points of data collection: 400 (63.1%) had a persistent and 234 (36.9%) a relapsing course. Statistically significant interactions were found between the group and time on disability (F (2,1258) = 23.779, p<0.001) and HRQoL (F (2,1252) = 82.779, p<0.001). In the adjusted model, the persistent course was associated with the disability level (OR 1.86, CI95% 1.40-2.40, p<0.001), depressive symptoms (OR 1.96, CI95% 1.21-3.18, p = 0.007), female gender (OR 1.90, CI95% 1.26-2.87, p = 0.002) and having a manual job (OR 1.46, CI95% 1.02-2.10, p = 0.040). CONCLUSION In the long-term, patients with CLBP may follow a persistent or relapsing course of pain. Being female, presenting depressive symptoms, having a manual job and higher disability at baseline predicts a persistent course of LBP.
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Affiliation(s)
- Luís Antunes Gomes
- CHRC, Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setubal, Portugal
- * E-mail:
| | - Ana Maria Rodrigues
- CHRC, Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Unidade de Reumatologia, Hospital dos Lusíadas, Lisbon, Portugal
| | - Jaime C. Branco
- CHRC, Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Serviço de Reumatologia do Hospital Egas Moniz—Centro Hospitalar Lisboa Ocidental (CHLO-EPE), Lisbon, Portugal
| | - Helena Canhão
- CHRC, Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- EpiDoC Unit, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Unidade de Reumatologia, Centro Hospitalar Universitário Lisboa Central–Hospital Santo António dos Capuchos (CHULC-EPE), Lisbon, Portugal
| | - Eduardo Brazete Cruz
- CHRC, Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setubal, Portugal
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Mediators and Moderators of Education Plus Exercise on Perceived Improvement in Individuals With Gluteal Tendinopathy: An Exploratory Analysis of a 3-Arm Randomized Trial. J Orthop Sports Phys Ther 2022; 52:826-836. [PMID: 36306175 DOI: 10.2519/jospt.2022.11261] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To investigate mediators and moderators of effects of an education-plus-exercise program compared to corticosteroid injections or wait and see on perceived improvement in individuals with gluteal tendinopathy. METHODS: Exploratory analysis from a clinical trial (n = 204) comparing education plus exercise, corticosteroid injection, and wait and see on global rating of change at 52 weeks. Potential mediators measured at baseline and 8 weeks were hip active abduction range, abductor muscle torque, pain self-efficacy, pain constancy, and patient-specific function. Potential moderators at baseline were Victorian Institute of Sport Assessment for gluteal tendinopathy, menopausal status, symptom duration, magnetic resonance imaging-determined tendon pathology, and pain catastrophizing. RESULTS: There is evidence from mediation analysis that the beneficial effect of education plus exercise on global rating of change relative to corticosteroid injection or wait and see may be due to changes in patient-specific function (indirect effect relative risk; 95% CI: 1.14 [1.05-1.29], 1.29 [1.12-1.58], respectively), pain constancy (1.12 [1.03-1.27], 1.2 [1.08-1.41]), and pain self-efficacy (1.1 [1.02-1.25], 1.18 [1.04-1.44])-not active hip movement/muscle torque. Moderation analysis did not support our included patient characteristics. CONCLUSION: Education plus exercise is likely to improve global rating of change for persons with gluteal tendinopathy relative to corticosteroid injection and wait and see through improvements in patient-specific function, pain self-efficacy, and reduced pain constancy. We found no evidence of differences in the effect of education plus exercise in patient subgroups based on disability, menopausal status, symptom duration, tendon pathology, or pain catastrophizing. J Orthop Sports Phys Ther 2022;52(12):826-836. Epub: 17 October 2022. doi:10.2519/jospt.2022.11261.
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Four Variables Were Sufficient for Low Back Pain: Determining Which Patient-Reported Tools Pain and Disability Improvements. J Orthop Sports Phys Ther 2022; 52:685-693. [PMID: 35960508 DOI: 10.2519/jospt.2022.11018] [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: 02/07/2023]
Abstract
OBJECTIVE: To predict 30- and 180-day improvements in disability and pain for patients seeking physical therapy care for low back pain (LBP). DESIGN: Longitudinal cohort. METHODS: Baseline assessment was completed by 259 patients with chief complaint of LBP, and the assessment includes psychosocial measures (Keele STarT Back Screening [SBST] and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag [OSPRO-YF] tools), the Optimal Screening for Prediction of Referral and Outcome Review of Symptoms (OSPRO-ROS) and the Review of Symptoms Plus (OSPRO-ROS+) tools, the Charlson Comorbidity Index (CCI), the Area Deprivation Index (ADI), and the National Institute of Health Chronic Pain Criteria (NIH-CP). Using the Modified Low Back Disability Questionnaire (MDQ) and the Numeric Pain Rating Scale (NPRS) as primary outcomes, statistical analysis determined multiple sets of predictor variables with similar model performance. RESULTS: The parsimonious "best model" for prediction of the 180-day MDQ change included 3 predictors (Admit MDQ, NIH-CP, and OSPRO ROS+) because it had the lowest penalized goodness-of-fit statistic (BIC = -35.21) and the highest explained variance (R2 = 0.295). The parsimonious "best model" for 180-day NPRS change included 2 variables (Admit NPRS and OSPRO-ROS+) with the lowest penalized goodness-of-fit statistic (BIC = -18.2) and the highest explained variance (R2 = 0.190). CONCLUSION: There were many model options with similar statistical performance when using established measures to predict MDQ and NPRS outcomes. A potential variable set for a standard predictive model that balances statistical performance with pragmatic considerations included the OSPRO-ROS+, OSPRO-YF, NIH-CP definition, and admit MDQ and NPRS scores. J Orthop Sports Phys Ther 2022;52(10):685-693. Epub: 12 August 2022. doi:10.2519/jospt.2022.11018.
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Lamper C, Huijnen IPJ, Kroese MEAL, Köke AJ, Brouwer G, Ruwaard D, Verbunt JAMCF. Exploring the feasibility of a network of organizations for pain rehabilitation: What are the lessons learned? PLoS One 2022; 17:e0273030. [PMID: 36107861 PMCID: PMC9477302 DOI: 10.1371/journal.pone.0273030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 08/01/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND AIMS Integration of care is lacking for chronic musculoskeletal pain patients. Network Pain Rehabilitation Limburg, a transmural health care network, has been designed to provide integrated rehabilitation care from a biopsychosocial perspective to improve patients' levels of functioning. This feasibility study aims to provide insight into barriers and facilitators for the development, implementation, and transferability. METHODS This study was conducted with a three-phase iterative and incremental design from October 2017 to October 2018. The network comprises two rehabilitation practices, and three local primary care networks, with a general practitioner together with, a mental health practice nurse, and a physiotherapist or exercise therapist. These stakeholders with a random sample of participating patients took part in evaluations, consisting of interviews, focus groups, and observations. Field notes and observations were recorded during meetings. The Consolidated Framework for Implementation Research guided data collection and analysis. Results were used to refine the next phase. RESULTS According to health care professionals, guidelines and treatment protocols facilitate consistency and transparency in collaboration, biopsychosocial language, and treatment. One mentioned barrier is the stigmatization of chronic pain by the general population. In regular care, approaches are often more biomedical than biopsychosocial, causing patients to resist participating. The current organization of health care acts as a barrier, complicating implementation between and within practices. Health care professionals were enthusiastic about the iterative, bottom-up development. A critical mass of participating organizations is needed for proper implementation. CONCLUSION Network Pain Rehabilitation Limburg is feasible in daily practice if barriers are overcome and facilitators of development, implementation, and transferability are promoted. These findings will be used to refine Network Pain Rehabilitation Limburg. A large-scale process and effect evaluation will be performed. Our implementation strategies and results may assist other health care organizations aspiring to implement a transmural network using a similar model. TRAIL REGISTRATION Registration number: NTR6654 or https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6654.
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Affiliation(s)
- Cynthia Lamper
- Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Ivan P. J. Huijnen
- Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands
| | - Mariëlle E. A. L. Kroese
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Albère J. Köke
- Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands
| | - Gijs Brouwer
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Dirk Ruwaard
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jeanine A. M. C. F. Verbunt
- Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands
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Naisby J, Amjad A, Ratcliffe N, Yarnall AJ, Rochester L, Walker R, Baker K. A Survey of People With Parkinson's and Their Carers: The Management of Pain in Parkinson's. J Geriatr Psychiatry Neurol 2022; 35:613-621. [PMID: 34235999 PMCID: PMC9210119 DOI: 10.1177/08919887211023592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pain in Parkinson's is problematic but under treated in clinical practice. Healthcare professionals must understand the impact of pain in Parkinson's and patient preferences for management. OBJECTIVE To understand the impact of pain in Parkinson's and to understand current management and preferences for pain management. METHODS We conducted a national survey with 115 people with Parkinson's (PwP) and 10 carers. Both closed and open questions were used. The questions focused on how pain affected the individual, healthcare professional involvement in supporting pain management, current pain management strategies and views on future pain management interventions. We used descriptive statistics to summarize closed responses and thematic analysis to summarize open question responses. RESULTS 70% of participants reported pain impacted their daily life. Pain had a multifactorial impact on participants, affecting movement, mood and quality of life. Improved pain management was viewed to have the potential to address each of these challenges. Pain affected a number of different sites, with low back pain and multiple sites being most frequently reported. Exercise was the most frequently noted strategy (38%) recommended by healthcare professionals for pain management. PwP would value involvement from healthcare professionals for future pain management, but also would like to self-manage the condition. Medication was not suggested as a first line strategy. CONCLUSIONS Despite reporting engagement in some strategies to manage pain, pain still has a wide-ranging impact on the daily life of PwP. Results from this survey highlight the need to better support PwP to manage the impact of pain.
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Affiliation(s)
- Jenni Naisby
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom,Clinical Ageing Research Unit, Institute of Neuroscience/Newcastle University Institute for Ageing, Newcastle University, Newcastle Upon Tyne, United Kingdom,Jenni Naisby, Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne NE1 8ST, United Kingdom.
| | | | | | | | - Lynn Rochester
- Clinical Ageing Research Unit, Institute of Neuroscience/Newcastle University Institute for Ageing, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom
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Patient Concerns and Beliefs Related to Audible Popping Sound and the Effectiveness of Manipulation: Findings From an Online Survey. J Manipulative Physiol Ther 2022; 45:144-152. [PMID: 35753885 DOI: 10.1016/j.jmpt.2022.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to assess whether beliefs about the origin of the popping sound and the effects of thrust manipulation (TM) were in agreement with current scientific evidence and whether a practitioner's explanation could influence patient beliefs of theoretical mechanisms. METHODS A cross-sectional online survey was conducted in Italy from January 7, 2019 to April 20, 2019. The questionnaire was sent to 900 Italian adults through online recruitment, including people with and without a history of manipulation, such as given by physiotherapists, chiropractors, osteopaths, and manual medicine physicians to manage musculoskeletal disorders. The questionnaire consisted of 11 multiple-choice questions and could be completed within 15 weeks. The Likert scale was used to investigate participants' attitudes. Sex and previous experience of TM variables were evaluated using a Student's t-test; a 1-way F analysis of variance test was performed to evaluate age, educational qualification, and the professional who performed the TM. RESULTS We retrieved 478 questionnaires, including 175 participants with no TM history and 303 with TM history. There were 31% of participants (n = 94) with a history of TM who reported they did not receive explanations regarding manipulation. The participants' beliefs mostly disagreed with the current hypotheses provided by the scientific literature on the theoretical mechanisms of popping sound (tribonucleation and cavitation). There were 9.9% (n = 30) of participants who answered "realignment of bone positional fault" to explain the mechanism behind TM. There was a high degree of agreement with the belief that the popping sound should be present for a successful TM (respectively, 2.8 standard deviation [SD; 1.2] and 2.6 SD [1.2] for TM+ and TM- participants). No statistically significant differences were found between participants with and without a history of TM. CONCLUSION The participants in this study reported a belief that popping was related to effectiveness of TM. A high percentage of this sample had beliefs about TM mechanisms for the audible popping sound that were inconsistent with current literature. Beliefs were similar between groups, suggesting that instructions given by TM practitioners did not seem to be an influence on these patients' beliefs.
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Hill J, Try F, Agnew G, Saywell N. Perspectives and experiences of physiotherapists and general practitioners in the use of the STarT Back Tool: a review and meta-synthesis. J Prim Health Care 2022; 14:164-172. [PMID: 35771704 DOI: 10.1071/hc21069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The STarT Back Tool (SBT) is used to triage people with acute low back pain (LBP) into treatment groups, matched to their risk of chronicity. It was developed in the UK where it has been shown to improve clinical outcomes, patient satisfaction, and reduce time off work. Successful implementation of the SBT outside the UK is dependent on health practitioner's attitudes and the healthcare system in which they work. Gaining health practitioners' perspectives on the SBT is an important step in implementation. Methods A computerised search of qualitative literature was conducted across seven databases in March 2021 using keywords to identify studies investigating the perspectives of physiotherapists and general practitioners on the use of the SBT in primary health care. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tool. Data were coded and analysed using reflexive thematic analysis. Results Eight articles met inclusion criteria and included the views of 76 physiotherapists and 65 general practitioners, working in primary health care in four countries. Three themes were created from the data: 'Making it work', identifies factors that influence implementation and continued use of the SBT. The second 'will I do it?', captured potential consequences of adopting the SBT, and the third, 'it's all about the patient' emphasised how the SBT may affect patients. Discussion Physiotherapists and general practitioners found using the SBT frequently enhanced practice. General practitioners expressed concerns about time constraints and the SBT's potential to undermine clinical experience. Findings from this study will inform modifications to contextualise the tool to each healthcare environment.
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Affiliation(s)
- Julia Hill
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; and Active Living and Rehabilitation: Aotearoa New Zealand, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Freya Try
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Georgia Agnew
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nicola Saywell
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Horment-Lara G, Lüttges-Sciaccaluga C, Espinoza-Ordóñez C, Aliaga-Castillo V. "I don't want to be a burden" A qualitative study of the beliefs of women with chronic low back pain in relation to their painful experience. Musculoskelet Sci Pract 2022; 59:102539. [PMID: 35278835 DOI: 10.1016/j.msksp.2022.102539] [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: 08/11/2021] [Revised: 01/27/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women's pain is still poorly understood. Moreover, maladaptive pain beliefs contribute to the disability associated with low back pain and play a key role in the transition from acute to chronic symptoms. OBJECTIVES To explore the beliefs of women with non-specific chronic low back pain in terms of nature of symptoms, fears associated with pain, expectations for recovery, family, social and work-related limitations, and perceived self-efficacy. DESIGN AND METHODS A qualitative study with an interpretative approach was undertaken. Face-to-face, semi-structured individual interviews were performed. Study participants were 10 women with non-specific chronic low back pain living in the Metropolitan Region of Chile. Thematic analysis was used to analyze the data. A deductive process was used to code the text and categorize the data. RESULTS Participants described maladaptive beliefs about pain, leading to fearful attitudes and low expectations for recovery. These beliefs seemed to perpetuate pain and limit engagement in daily tasks and meaningful activities. Some of these beliefs were associated with information provided by healthcare professions. Despite having maladaptive beliefs, women perceived themselves as self-effective. CONCLUSION Women with chronic low back pain described a range of different pain beliefs across a complex categorial structure. The contents of such structure may interfere with their decisions about therapeutic options. Their beliefs were often ungrounded in scientific principles, even if the information may have been provided by healthcare providers. Physical therapists would benefit from these findings to improve communication with their patients and assess the role of beliefs in decision-making.
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Affiliation(s)
| | | | - César Espinoza-Ordóñez
- Clínica Quilín, Universidad de Chile, Santiago, Chile; Department of Health Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
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Sherman KJ, Wellman RD, Jones SM, Lewis CC. Interest in Mindfulness Training for Chronic Low-Back Pain: Results from a Vignette-driven, Web-based Survey of Patients. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:484-496. [PMID: 35352963 PMCID: PMC9232229 DOI: 10.1089/jicm.2021.0427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Mindfulness-based stress reduction (MBSR) has been found effective for improving chronic low-back pain (cLBP). However, little data exist regarding how attractive this technique is to Americans as a therapy for cLBP. Design: Survey of randomly selected persons with cLBP. Settings/Location: Respondents were recruited from Kaiser Permanente Washington and one-time surveys were completed online. Patients: Adults 18-80 years of age with cLBP. Surveys: The study was conducted between December 2019 and August 2020. Outcome measures: The survey described an evidence-based classic MBSR course and then asked respondents about their sociodemographic characteristics, their current back pain, previous back pain treatments, behavioral risk factors for back pain, and four outcomes indicative of intention to engage in MBSR. Results: Four-hundred fifty-seven respondents completed the survey. Respondents were primarily women, white, educated, and with back pain for more than 5 years. About half had previously used a mind-body therapy for their pain. Overall, they reported moderate to high intention to try mindfulness classes and practice at home (median of 5 with 50% of the observations between 4 and 6, and 5.7, 50% of the observations between 4.3 and 6.3, respectively, on a 7-point scale). They reported a willingness to spend a median of 3 h/week learning mindfulness and 3.5 h/week practicing mindfulness techniques (for both outcomes, 50% of the respondents reported between 2 and 5 h). Few patient characteristics predicted intention to engage in MBSR, with no variable predicting all outcomes. The magnitude of the effect associated with significant predictors was small. Conclusion: Classic MBSR appealed to many survey respondents, in that they reported high interest in learning MBSR and intention to practice at home. The amount of time they reported being willing to spend learning MBSR and practicing at home is consistent with the time commitment in the original course.
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Affiliation(s)
- Karen J. Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Address correspondence to: Karen J. Sherman, PhD, Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA
| | - Robert D. Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | | | - Cara C. Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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The Portuguese osteopaths attitudes towards a biomechanical or biopsychosocial model in the approach of chronic low back pain – A cross-sectional questionnaire-based survey. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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The association between patients' illness perceptions and longitudinal clinical outcome in patients with low back pain. Pain Rep 2022; 7:e1004. [PMID: 35505791 PMCID: PMC9049027 DOI: 10.1097/pr9.0000000000001004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/16/2023] Open
Abstract
Initial perceptions regarding prognosis and treatment effects were prominent perceptions explaining longitudinal outcomes in patients with low back pain, including explaining patients' development of self-management strategies. Introduction: Illness perception is suggested to influence outcome in patients with low back pain (LBP). It is unknown if specific illness perceptions are of more importance for longitudinal outcomes, including development of self-management strategies. Objectives: This study explores whether patients' initial illness perceptions were associated with disability, pain, health-related quality of life, and self-care enablement outcomes in patients with LBP after 3 and 12 months. Methods: Four hundred sixty-seven consecutive patients seeking physiotherapeutic primary care for LBP were eligible to participate in this prospective cohort study, providing data at baseline and after 3 and 12 months (mean age 45 years, 56% women). Multiple linear regression analysis was used to explore whether patients' illness perceptions at baseline were associated with outcome in the Oswestry Disability Index (ODI), Numeric Rating Scale–LBP (NRS-LBP), EuroQol Five Dimensions, and Patient Enablement Instrument (PEI). Results: Stronger beliefs that the back problem will last a long time at baseline were associated with worse outcome in ODI, NRS-LBP, and PEI at 3 and 12 months and in EuroQol Five Dimensions at 12 months. Negative beliefs regarding treatment's ability to improve LBP were associated with worse outcome in NRS-LBP and PEI at 3 and 12 months and in ODI at 12 months. Conclusions: Illness perceptions regarding prognosis and treatment's ability to improve symptoms were the most prominent perceptions explaining several longitudinal clinical outcomes. These expectations should be addressed in an early stage in the delivery of interventions for LBP. These expectations were also important for patients' development of coping and self-management strategies.
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Klyne DM, Hall LM, Nicholas MK, Hodges PW. Risk factors for low back pain outcome: Does it matter when they are measured? Eur J Pain 2022; 26:835-854. [PMID: 35090067 PMCID: PMC9303691 DOI: 10.1002/ejp.1911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The early identification of factors that increase risk of poor recovery from acute low back pain (LBP) is critical to prevent the transition to chronicity. Although most studies of risk factors for poor outcome in LBP tend to investigate the condition once it is already persistent, there is evidence to suggest that this differs from risk factors measured during the early-acute stage. This study aimed to identify early risk factors for poor outcome in the short- and long-term in individuals with acute LBP, and to compare this with factors identified at 3 months in the same cohort. METHODS One hundred and thirty-three individuals were recruited within 2 weeks of an acute LBP episode and completed questionnaires related to their sociodemographic, psychological, clinical and history/treatment status at baseline and 3 months later, and their pain-level fortnightly for 12 months. RESULTS Of the 133 participants recruited, follow-up data was provided by 120 at 3 months, 97 at 6 months, 85 at 9 months and 94 at 12 months. Linear regression identified various factors at baseline (acute phase) and 3 months later that predicted short- and long-term outcome (pain level, change in pain). Key findings were that: (1) depressive symptoms at baseline most consistently predicted worse outcome; (2) psychological factors in general at 3 months were more predictive of outcome than when measured at baseline; (3) early health care utilisation predicted better outcome, whereas use of pain medication later (3 months) predicted worse outcome; and (4) sex and BMI predicted outcome inconsistently over 12-months. CONCLUSIONS The results highlight the multidimensional nature of risk factors for poor outcome in LBP and the need to consider time variation in these factors.
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Affiliation(s)
- D M Klyne
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - L M Hall
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - M K Nicholas
- Pain Management Research Institute, Royal North Shore Hospital, The University of Sydney, Sydney, Australia
| | - P W Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Kahere M, Ginindza T. The prevalence and psychosocial risk factors of chronic low back pain in KwaZulu-Natal. Afr J Prim Health Care Fam Med 2022; 14:e1-e8. [PMID: 35144452 PMCID: PMC8831989 DOI: 10.4102/phcfm.v14i1.3134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) is the leading cause of disability and has been extensively investigated in high-income countries (HICs), with little done in low-and middle-income countries. Biomechanical stressors do not have a major pathogenic role, but psychosocial predisposition is important. The occurrence and progression of CLBP are significantly affected by psychosocial risk factors. Guidelines recommend the early identification of psychosocial factors that could predict CLBP. AIM To determine the prevalence and psychosocial risk factors for CLBP amongst adults in KwaZulu-Natal, South Africa. SETTING The study was conducted at five randomly selected public hospitals in KwaZulu-Natal. METHODS Analytical cross-sectional hospital-based study utilising a self-administered questionnaire to collect data on (1) sociodemographic, (2) disability, (3) fear-avoidance beliefs and (4) illness behaviour. The Statistical Package for the Social Sciences (SPSS) 24.0 was used for data cleaning and descriptive statistics. Chi-square test was used for categorical variables. Standard Edition of the Statistical Software for Data Science version 17.0 (STATA 17.0 SE) was used to identify risk factors using the logistic regression analysis. A p-value of ≤ 0.05 was deemed statistically significant. RESULTS Overall prevalence of CLBP was 22.2% (95% confidence interval [CI]: 18.8-25.9). Females had a higher prevalence of CLBP than males, 23.9% (95% CI: 19.4-28.9) and 19.7% (95% CI: 14.8-25.5), respectively; however, the difference was not significant p = 0.243. The multivariate regression analysis identified the following risk factors: female gender, middle-aged adults 38-47 years, obesity, disease conviction, affective disturbance, denial and fear-avoidance behaviour-work subscale. CONCLUSION There is a high prevalence of CLBP amongst the study participants. Psychosocial factors (disease conviction, affective disturbance and fear-avoidance behaviour about work) are significant predictors of CLBP.
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Affiliation(s)
- Morris Kahere
- Discipline of Public Health Medicine, School of Nursing and Public Health, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
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32
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Alhowimel AS, Alotaibi MA, Alamam DM, Alodaibi FA, Fritz JM. Attitudes and Beliefs of Primary Care Physicians Working in Saudi Arabia Regarding the Management of Low Back Pain: A Cross-Sectional Study. Int J Gen Med 2022; 14:10225-10233. [PMID: 35002292 PMCID: PMC8728917 DOI: 10.2147/ijgm.s343775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/10/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Healthcare professionals’ beliefs and attitudes towards low back pain management play a significant role during treatment. This is a crucial aspect of primary care physicians working as a first point of contact for people seeking healthcare for low back pain. Aim To identify the beliefs and behaviors of frontline healthcare professionals (primary care physicians) working in the Riyadh region with regard to low back pain management. Methods A cross-sectional design was implemented, in which the Pain Attitude and Beliefs Scale (PABS) questionnaire was used along with a low back pain clinical vignette with some questions. The PABS assesses healthcare provider orientations toward low back pain with two subscales: biomedical and behavioral. In total, 400 primary care physicians working in the Riyadh region of Saudi Arabia were invited to participate. Results The responding primary care physicians (n = 72, response rate = 18%) provided an average score on the behavioral subscale (mean = 31.5±7.1) that was lower than that on the biomedical subscale (36.5±7.8) of the PABS. The lower scores in the biomedical subscale are associated with the using of clinical guidelines for low back pain management (χ2 (1) = 4.7, p = 0.03). Moreover, providing guideline-based advices regarding activity and work was more likely to come from those scoring above the mean in the behavioral subscale. Conclusion The results of this study show that Saudi Arabian primary care physicians manage their patients within a biomedical framework; there is some compliance to the current low back pain clinical guidelines among these physicians, with under/post-graduate education being needed for these professionals to adopt a more biopsychosocial framework during low back pain management.
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Affiliation(s)
- Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Mazyad A Alotaibi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Dalyah M Alamam
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Faris A Alodaibi
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
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33
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Bier JD, Kuijer MR, de Jong A, Verhagen A. Improving the Predictive Validity of the Dutch STarT Back Tool. Phys Ther 2021; 101:6365143. [PMID: 34499179 DOI: 10.1093/ptj/pzab211] [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: 03/04/2021] [Revised: 05/28/2021] [Accepted: 08/17/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether the predictive validity of the Dutch version of the STarT Back Tool (SBT) can be improved by (1) using other cut-off values, (2) changing the items, or (3) adding prognostic factors to the SBT. DESIGN This was a secondary analysis of a prospective cohort study (PRINS study: Prevalence of Risk groups in Neck- and back pain patients according to the STarT back screening tool) in patients with low back or neck pain. METHODS The predictive validity was calculated with a relative risk ratio and a Spearman correlation. The new cut-off values were calculated with receiver operating characteristic curves. Replacing items of the SBT and adding new items were assessed with logistic regression analyses. RESULTS A total of 150 patients were included; 51% were categorized as having low risk, 39% as moderate risk, and 11% as high risk. Changing the cut-off total score to ≤2 and the subscore to ≥5 led to an improvement of the Spearman correlation and RR. Adding the item "duration of the complaints" improved the RR for moderate risk (3.6) (95% CI = 1.6-7.9) and for high risk (9.0) (95% CI = 4.2-19.1) compared with low risk. The new Spearman correlation was improved to rs = 0.37. CONCLUSION The predictive validity was improved by adding the item "duration of the complaints" and changing the cut-off values.
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Affiliation(s)
- Jasper D Bier
- Department of General Practice, Erasmus MC, Rotterdam, the Netherlands.,FS Fysio, Capelle aan den IJssel, the Netherlands
| | - Milou R Kuijer
- Department of General Practice, Erasmus MC, Rotterdam, the Netherlands.,FS Fysio, Capelle aan den IJssel, the Netherlands.,Hogeschool Utrecht, Utrecht, the Netherlands
| | | | - Arianne Verhagen
- Department of General Practice, Erasmus MC, Rotterdam, the Netherlands.,Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
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34
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Miki T, Higuchi D, Takebayashi T, Samukawa M. Factors associating with disability of non-specific low back pain in different subgroups: A hierarchical linear regression analysis. Sci Rep 2021; 11:18278. [PMID: 34521894 PMCID: PMC8440506 DOI: 10.1038/s41598-021-97569-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
This study aimed to explore factors associating with disability, which means physical impairment affecting a person’s mobility, capacity, stamina, or agility, of non-specific low back pain (NSLBP) of the acute and non-acute groups. Two hundred thirty-five patients with NSLBP of less than 8 weeks’ duration as acute groups (n = 124) and more than 8 weeks’ duration as non-acute group (n = 111) were recruited. It was collected data on pain intensity, disability and psychosocial factors, including pain catastrophising, fear of movement and pain self-efficacy. Disability was measured Roland Morris Disability Questionnaire. A hierarchical multiple regression analysis was performed to analyse factors associating with disability of the acute and non-acute groups. The Result was that explanatory power increased with each additional variable of the order of demographic characteristics, pain intensity and psychosocial factors for both groups. Pain intensity, pain catastrophising and pain self-efficacy had significant explanatory power, with pain self-efficacy having the most significant association on the acute group. Only pain self-efficacy having the most significant association on disability of the non-acute group. In conclusion, the factors associating with disability differed depending on the duration of the disease, and pain self-efficacy might be one of the factors associating with disability of patients with NSLBP.
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Affiliation(s)
- Takahiro Miki
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, N7, W27, Chuo, Sapporo, Hokkaido, 006-0007, Japan. .,Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | - Daisuke Higuchi
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Tsuneo Takebayashi
- Department of Orthopedic, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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35
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Schumann ME, Coombes BJ, Gascho KE, Geske JR, McDermott MC, Morrison EJ, Reynolds AL, Bernau JL, Gilliam WP. Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up. PAIN MEDICINE 2021; 23:697-706. [PMID: 34519826 DOI: 10.1093/pm/pnab271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/15/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Decreasing pain catastrophizing and improving self-efficacy to self-manage chronic pain symptoms are important treatment targets in the context of interdisciplinary cognitive behavioral therapy for chronic pain. Greater pain catastrophizing has been shown to be associated with greater impact of pain symptoms on functioning, while conversely, greater pain self-efficacy has been associated with lower pain intensity and lower levels of disability. OBJECTIVE To prospectively evaluate interdisciplinary cognitive behavioral therapy for pain outcomes, as well as to the mediating effects of both pain catastrophizing and pain self-efficacy on outcome. METHODS Participants were 315 patients with chronic pain between April 2017 and April 2018 who completed a three-week interdisciplinary pain rehabilitation program. Pain severity, pain interference, pain catastrophizing, pain self-efficacy, quality of life, and depressive symptom questionnaires, and measures of physical performance were assessed at pre- and posttreatment. Follow-up questionnaires were returned by 163 participants. Effect size and reliable change analyses were conducted from pre- to posttreatment and pretreatment to 6-month follow-up. Mediation analyses were conducted to determine the mediating effect of pain catastrophizing and pain self-efficacy on pain outcome. RESULTS Significant improvements from pre- to posttreatment in pain outcomes were observed, and over 80% evidenced reliable change in at least one pain-relevant measure. Pain catastrophizing and pain self-efficacy mediated the relationship between changes in pain outcomes. CONCLUSIONS Interdisciplinary pain rehabilitation is an effective treatment and decreasing pain catastrophizing and increasing pain self-efficacy can influence maintenance of treatment gains.
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Affiliation(s)
- Matthew E Schumann
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Brandon J Coombes
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Keith E Gascho
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jennifer R Geske
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Mary C McDermott
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Andrea L Reynolds
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jessica L Bernau
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Wesley P Gilliam
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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36
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Brunner E, Meichtry A, Vancampfort D, Imoberdorf R, Gisi D, Dankaerts W, Graf A, Wipf Rebsamen S, Suter D, Wildi LM, Buechi S, Sieber C. Influence of weekday of admission and level of distress on length of hospital stay in patients with low back pain: a retrospective cohort study. BMC Musculoskelet Disord 2021; 22:656. [PMID: 34353298 PMCID: PMC8340547 DOI: 10.1186/s12891-021-04529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is often a complex problem requiring interdisciplinary management to address patients' multidimensional needs. Providing inpatient care for patients with LBP in primary care hospitals is a challenge. In this setting, interdisciplinary LBP management is often unavailable during weekends. Delays in therapeutic procedures may result in a prolonged length of hospital stay (LoS). The impact of delays on LoS might be strongest in patients reporting high levels of psychological distress. Therefore, this study investigates the influence of weekday of admission and distress on LoS of inpatients with LBP. METHODS This retrospective cohort study was conducted between 1 February 2019 and 31 January 2020. In part 1, a negative binomial model was fitted to LoS with weekday of admission as a predictor. In part 2, the same model included weekday of admission, distress level, and their interaction as covariates. Planned contrast was used in part 1 to estimate the difference in log-expected LoS between group 1 (admissions Friday/Saturday) and the reference group (admissions Sunday-Thursday). In part 2, the same contrast was used to estimate the corresponding difference in (per-unit) distress trends. RESULTS We identified 173 patients with LBP. The mean LoS was 7.8 days (SD = 5.59). Patients admitted on Friday (mean LoS = 10.3) and Saturday (LoS = 10.6) had longer stays, but not those admitted on Sunday (LoS = 7.1). Analysis of the weekday effect and planned contrast showed that admission on Friday or Saturday was associated with a significant increase in LoS (log ratio = 0.42, 95% CI = 0.21 to 0.63). A total of 101 patients (58%) returned questionnaires, and complete data on distress were available from 86 patients (49%). According to the negative binomial model for LoS and the planned contrast, the distress effect on LoS was significantly influenced (difference in slopes = 0.816, 95% CI = 0.03 to 1.60) by dichotomic weekdays of admission (Friday/Saturday vs. Sunday-Thursday). CONCLUSIONS Delays in interdisciplinary LBP management over the weekend may prolong LoS. This may particularly affect patients reporting high levels of distress. Our study provides a platform to further explore whether interdisciplinary LBP management addressing patients' multidimensional needs reduces LoS in primary care hospitals.
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Affiliation(s)
- Emanuel Brunner
- Department of Physiotherapy and Rehabilitation, Winterthur Cantonal Hospital, Brauerstrasse 15, CH-801 Winterthur, Switzerland
- Department of Health, OST – Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - André Meichtry
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Reinhard Imoberdorf
- Department of Internal Medicine, Winterthur Cantonal Hospital, Winterthur, Switzerland
| | - David Gisi
- Department of Physiotherapy and Rehabilitation, Winterthur Cantonal Hospital, Brauerstrasse 15, CH-801 Winterthur, Switzerland
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Anita Graf
- Department of Physiotherapy and Rehabilitation, Winterthur Cantonal Hospital, Brauerstrasse 15, CH-801 Winterthur, Switzerland
| | - Stefanie Wipf Rebsamen
- Department of Physiotherapy and Rehabilitation, Winterthur Cantonal Hospital, Brauerstrasse 15, CH-801 Winterthur, Switzerland
| | - Daniela Suter
- Department of Medicine, Nursing, Winterthur Cantonal Hospital, Winterthur, Switzerland
| | - Lukas Martin Wildi
- Department of Medicine, Institute of Rheumatology, Winterthur Cantonal Hospital, Winterthur, Switzerland
| | - Stefan Buechi
- Clinic for Psychotherapy and Psychosomatics “Hohenegg”, Meilen, Switzerland
| | - Cornel Sieber
- Department of Internal Medicine, Winterthur Cantonal Hospital, Winterthur, Switzerland
- Institute for Biomedicine of Ageing, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
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Igwesi-Chidobe CN, Sorinola IO, Godfrey EL. The Igbo Brief Illness Perceptions Questionnaire: A cross-cultural adaptation and validation study in Nigerian populations with chronic low back pain. J Back Musculoskelet Rehabil 2021; 34:399-411. [PMID: 33459695 DOI: 10.3233/bmr-191687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Illness perceptions predict chronic low back pain (CLBP) disability. This study cross-culturally adapted and validated the Igbo Brief Illness Perceptions Questionnaire (Igbo-BIPQ) in people with CLBP in rural/urban Nigeria. METHODS A cross-cultural adaptation and validation of the Igbo-BIPQ was undertaken. The BIPQ was forward/back-translated by clinical/non-clinical translators. An expert review committee appraised the translations. The questionnaire was pre-tested on twelve rural Nigerian dwellers with CLBP. Internal consistency using Cronbach's alpha; test-retest reliability using intra-class correlation coefficient and Bland-Altman plot; and minimal detectable change were investigated amongst 50 people with CLBP in rural and urban Nigeria. Construct validity was determined by correlating the Igbo-BIPQ score with those of eleven-point box scale and Igbo Roland Morris Disability Questionnaire (Igbo-RMDQ) using Pearson's correlation analyses in 200 adults with CLBP in rural Nigeria. Ceiling and floor effects were investigated in both samples. RESULTS Good face/content validity, internal consistency (α= 0.76) and intraclass correlation coefficient (ICC = 0.78); standard error of measurement and minimal detectable change of 5.44 and 15.08 respectively; moderate correlations with pain intensity and self-reported disability (r⩾ 0.4); no ceiling/floor effects were observed for Igbo-BIPQ. CONCLUSION This study provides evidence of some aspects of validity and reliability of the Igbo-BIPQ.
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Affiliation(s)
- Chinonso N Igwesi-Chidobe
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria (Enugu Campus), Nsukka, Nigeria.,Department of Physiotherapy, School of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Isaac O Sorinola
- Department of Physiotherapy, School of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Emma L Godfrey
- Department of Physiotherapy, School of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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van der Gaag WH, Chiarotto A, Heymans MW, Enthoven WT, van Rijckevorsel-Scheele J, Bierma-Zeinstra SM, Bohnen AM, Koes BW. Developing clinical prediction models for nonrecovery in older patients seeking care for back pain: the back complaints in the elders prospective cohort study. Pain 2021; 162:1632-1640. [PMID: 33394879 PMCID: PMC8120685 DOI: 10.1097/j.pain.0000000000002161] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/23/2022]
Abstract
ABSTRACT Back pain is a leading cause of disability worldwide and is common in older adults. No clinical prediction models for poor long-term outcomes have been developed in older patients with back pain. This study aimed to develop and internally validate 3 clinical prediction models for nonrecovery in this population. A prospective cohort study in general practice was conducted (Back Complaints in the Elders, Netherlands), including 675 patients >55 years with a new episode of care for back pain. Three definitions of nonrecovery were used combining 6-month and 12-month follow-up data: (1) persistent back pain, (2) persistent disability, and (3) perceived nonrecovery. Sample size calculation resulted in a maximum of 14 candidate predictors that were selected from back pain prognostic literature and clinical experience. Multivariable logistic regression was used to develop the models (backward selection procedure). Models' performance was evaluated with explained variance (Nagelkerke's R2), calibration (Hosmer-Lemeshow test), and discrimination (area under the curve [AUC]) measures. The models were internally validated in 250 bootstrapped samples to correct for overoptimism. All 3 models displayed good overall performance during development and internal validation (ie, R2 > 30%; AUC > 0.77). The model predicting persistent disability performed best, showing good calibration, discrimination (AUC 0.86, 95% confidence interval 0.83-0.89; optimism-adjusted AUC 0.85), and explained variance (R2 49%, optimism-adjusted R2 46%). Common predictors in all models were: age, chronic duration, disability, a recent back pain episode, and patients' recovery expectations. Spinal morning stiffness and pain during spinal rotation were included in 2 of 3 models. These models should be externally validated before being used in a clinical primary care setting.
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Affiliation(s)
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
- Department of Epidemiology & Biostatistics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Wendy T.M. Enthoven
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - Sita M.A. Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Orthopedics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Arthur M. Bohnen
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bart W. Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Center for Muscle and Health, University of Southern Denmark, Odense, Denmark
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Vejlgaard C, Maribo T, Riisgaard Laursen J, Schmidt AM. Reliability and smallest detectable change of the Danish version of the Pain Self-Efficacy Questionnaire in patients with chronic low back pain. Scand J Pain 2021; 21:809-813. [PMID: 34062626 DOI: 10.1515/sjpain-2021-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/30/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Low back pain (LBP) is the leading cause of disability and a global public health concern. Studies indicate that pain self-efficacy is associated with the development of disability in chronic LBP (CLBP) patients. The Pain Self-Efficacy Questionnaire (PSEQ) is a commonly used questionnaire to assess pain self-efficacy in patients with CLBP. It is essential to examine the psychometric properties of the PSEQ in the population in which it is to be used. Thus, the aim of this study is to evaluate the reliability and smallest detectable change of the Danish version of the Pain Self-Efficacy Questionnaire (PSEQ-DK) in patients with CLBP before implementing it as an outcome measure in an inpatient rehabilitation context. METHODS This observational study including 92 patients with CLBP was conducted in a multidisciplinary rehabilitation facility in Denmark. The psychometric properties statistically tested included reliability, smallest detectable change and floor and ceiling effect of the PSEQ-DK. RESULTS The reliability analysis included 92 patients and revealed an weighted kappa of 0.82 (95% Cl 0.75; 0.88) and Intraclass correlation coefficient of 0.83 (95% CI 0.75; 0.88), which corresponds to a good reliability. The smallest detectable change was 12.67. CONCLUSIONS The present study demonstrated that the PSEQ-DK had a good reliability in patients with CLBP in an inpatient rehabilitation context. The current results expand our knowledge of the reliability and smallest detectable change of the PSEQ-DK. In order to implement PSEQ-DK in a rehabilitation context for evaluative purposes future studies should focus on examining responsiveness and interpretability.
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Affiliation(s)
- Camilla Vejlgaard
- The Faculty of Health, Aarhus University, Aarhus, Denmark.,Sano Aarhus, Aarhus, Denmark
| | - Thomas Maribo
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | | | - Anne Mette Schmidt
- Sano Aarhus, Aarhus, Denmark.,Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
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Semrau J, Hentschke C, Peters S, Pfeifer K. Effects of behavioural exercise therapy on the effectiveness of multidisciplinary rehabilitation for chronic non-specific low back pain: a randomised controlled trial. BMC Musculoskelet Disord 2021; 22:500. [PMID: 34051780 PMCID: PMC8164753 DOI: 10.1186/s12891-021-04353-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The long-term effects of behavioural medical rehabilitation (BMR), as a type of multidisciplinary rehabilitation, in the treatment of chronic non-specific low back pain (CLBP) have been shown. However, the specific effects of behavioural exercise therapy (BET) compared to standard exercise therapy (SET) within BMR are not well understood. The aim of the study was to assess the effectiveness of BMR + BET compared to BMR + SET in individuals with CLBP in a two-armed, pre-registered, multicentre, parallel, randomised controlled trial (RCT). METHODS A total of 351 adults with CLBP in two rehabilitation centres were online randomised based on an 'urn randomisation' algorithm to either BMR + SET (n = 175) or BMR + BET (n = 176). Participants in both study groups were non-blinded and received BMR, consisting of an multidisciplinary admission, a psychosocial assessment, multidisciplinary case management, psychological treatment, health education and social counselling. The intervention group (BMR + BET) received a manualised, biopsychosocial BET within BMR. The aim of BET was to develop self-management strategies in coping with CLBP. The control group (BMR + SET) received biomedical SET within BMR with the aim to improve mainly physical fitness. Therapists in both study groups were not blinded. The BMR lasted on average 27 days, and both exercise programmes had a mean duration of 26 h. The primary outcome was functional ability at 12 months. Secondary outcomes were e.g. pain, avoidance-endurance, pain management and physical activity. The analysis was by intention-to-treat, blinded to the study group, and used a linear mixed model. RESULTS There were no between-group differences observed in function at the end of the BMR (mean difference, 0.08; 95% CI - 2.82 to 2.99; p = 0.955), at 6 months (mean difference, - 1.80; 95% CI; - 5.57 to 1.97; p = 0.349) and at 12 months (mean difference, - 1.33; 95% CI - 5.57 to 2.92; p = 0.540). Both study groups improved in the primary outcome and most secondary outcomes at 12 months with small to medium effect sizes. CONCLUSION BMR + BET was not more effective in improving function and other secondary outcomes in individuals with CLBP compared to BMR + SET. TRIAL REGISTRATION Current controlled trials NCT01666639 , 16/08/2012.
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Affiliation(s)
- Jana Semrau
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Gebbertstraße 123 b, 91056, Erlangen, Germany.
| | | | - Stefan Peters
- Deutscher Verband für Gesundheitssport und Sporttherapie (DVGS) e.V, Vogelsanger Weg 48, 50354, Hürth-Efferen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Gebbertstraße 123 b, 91056, Erlangen, Germany
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41
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Blokzijl J, Dodd RH, Copp T, Sharma S, Tcharkhedian E, Klinner C, Maher CG, Traeger AC. Understanding overuse of diagnostic imaging for patients with low back pain in the Emergency Department: a qualitative study. Emerg Med J 2021; 38:529-536. [PMID: 34045266 DOI: 10.1136/emermed-2020-210345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/02/2020] [Accepted: 04/25/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Overuse of lumbar imaging in the Emergency Department is a well-recognised healthcare challenge. Studies to date have not provided robust evidence that available interventions can reduce overuse. For an intervention aimed at reducing imaging to be effective, insight into how both patients and clinicians view lumbar imaging tests is essential. AIM To explore factors that might influence overuse of lumbar imaging in the Emergency Department. METHODS Participants were recruited from three hospitals in Sydney, Australia between April and August 2019. We conducted focus groups and/or interviews with 14 patients and 12 clinicians. Sessions were audio-recorded and transcribed verbatim. Data were analysed using framework analysis by a team of four researchers with diverse backgrounds. RESULTS Patients described feeling that the decision about lumbar imaging was made by their Emergency Department clinician and reported little involvement in the decision-making process. Other potential drivers of lumbar imaging overuse from the patients' perspective were strong expectations for lumbar imaging, a reluctance to delay receiving a diagnosis, and requirements from third parties (eg, insurance companies) to have imaging. Emergency Department clinicians suggested that the absence of an ongoing therapeutic relationship, and the inability to manage perceived patient pressure could drive overuse of lumbar imaging. Suggested protective factors included: involving patients in the decision, ensuring clinicians have the ability to explain the reasons to avoid imaging and collaborative approaches to care both within the Emergency Department and with primary care. CONCLUSION AND KEY FINDINGS We found several factors that could contribute to overuse of lumbar imaging in the Emergency Department. Solutions to overuse of lumbar imaging in the Emergency Department could include: (1) strategies to involve patients in decisions about imaging; (2) training and support to provide thorough and well explained clinical assessment for low back pain; and (3) systems that support collaborative approaches to care.
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Affiliation(s)
- Johan Blokzijl
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht Brain Centre, Utrecht, Netherlands.,Institute for Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Rachael H Dodd
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Tessa Copp
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Sweekriti Sharma
- Institute for Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | | | - Christiane Klinner
- Institute for Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia .,Wiser Healthcare, Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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42
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Sánchez-Rodríguez E, Aragonès E, Jensen MP, Tomé-Pires C, Rambla C, López-Cortacans G, Miró J. The Role of Pain-Related Cognitions in the Relationship Between Pain Severity, Depression, and Pain Interference in a Sample of Primary Care Patients with Both Chronic Pain and Depression. PAIN MEDICINE 2021; 21:2200-2211. [PMID: 32100028 DOI: 10.1093/pm/pnz363] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aims of this study were twofold: 1) to better understand the associations between pain-related cognitions and pain severity, and psychological and physical function, and 2) to determine the extent to which these cognitions function as mediators in the association between pain severity and depression in a sample of primary care adult patients with chronic pain and depression. DESIGN Cross-sectional design. METHODS Three hundred twenty-eight patients with both depression and chronic pain from primary care centers responded to measures of pain severity, pain interference, depression severity, and pain-related cognitions (including measures of catastrophizing and other pain-related beliefs). We performed three hierarchical regression analyses and two multiple regression analyses. RESULTS The helplessness domain of pain catastrophizing was positively associated with pain severity, depression severity, and pain interference and mediated the relationship between depression and pain severity and vice versa. Beliefs about disability showed a positive association with pain severity, pain interference, and depression severity, and also mediated the relationship between pain severity and depression. Believing in a medical cure was positively associated with pain interference and negatively associated with depression; emotion beliefs were positively associated with pain severity. CONCLUSIONS These findings provide important new information about the associations between several pain-related cognitions and pain severity, depression, and pain interference and the potential mediating roles that these cognitions play in the associations between pain severity and depression in patients with both chronic pain and depression in the primary care setting.
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Affiliation(s)
- Elisabet Sánchez-Rodríguez
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain
| | - Enric Aragonès
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Catarina Tomé-Pires
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Concepció Rambla
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Germán López-Cortacans
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Jordi Miró
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain
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Serafino F, Trucco M, Occhionero A, Cerone GL, Chiarotto A, Vieira T, Gallina A. Understanding regional activation of thoraco-lumbar muscles in chronic low back pain and its relationship to clinically relevant domains. BMC Musculoskelet Disord 2021; 22:432. [PMID: 33975570 PMCID: PMC8114502 DOI: 10.1186/s12891-021-04287-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Altered regional activation of the lumbar extensors has been previously observed in individuals with low back pain (LBP) performing high-effort and fatiguing tasks. It is currently unknown whether similar alterations can be observed during low-effort functional tasks. Similarly, previous studies did not investigate whether side differences in regional activation are present in individuals with LBP. Finally, there is limited evidence of whether the extent of the alteration of regional activation is associated with clinical factors. Therefore, the aim of this study was to investigate whether individuals with LBP exhibit asymmetric regional activation of the thoraco-lumbar extensor muscles during functional tasks, and if the extent of neuromuscular control alteration is associated with clinical and psychosocial outcome domains. METHODS 21 participants with and 21 without LBP performed five functional tasks (gait, sit-to-stand, forward trunk flexion, shoulder flexion and anterior pelvic tilt). The spatial distribution of activation of the thoraco-lumbar extensor muscles was assessed bilaterally using high-density electromyography. For each side, the distribution of electromyographic (EMG) amplitude was characterized in terms of intensity, location and size. Indices of asymmetry were calculated from these features and comparisons between groups and tasks were performed using ANOVA. The features that significantly differed between groups were correlated with self-reported measures of pain intensity and other outcome domains. RESULTS Indices of asymmetry did not differ between participants with and without LBP (p > 0.11). The cranio-caudal location of the activation differed between tasks (p < 0.05), but not between groups (p = 0.64). Participants with LBP showed reduced EMG amplitude during anterior pelvic tilt and loading response phase during gait (both p < 0.05). Pearson correlation revealed that greater pain intensity was associated with lower EMG amplitude for both tasks (R<-0.5, p < 0.05). CONCLUSIONS Despite clear differences between tasks, individuals with and without LBP exhibited similar distributions of EMG amplitude during low-effort functional activities, both within and between sides. However, individuals with LBP demonstrated lower activation of the thoraco-lumbar muscles during gait and anterior pelvic tilt, especially those reporting higher pain intensity. These results have implications in the development or refinement of assessment and intervention strategies focusing on motor control in patients with chronic LBP.
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Affiliation(s)
- Francesca Serafino
- Presidio Sanitario San Camillo, Torino, Italy.,Montecatone Rehabilitation Institute, Imola, BO, Italy
| | - Marco Trucco
- Presidio Sanitario San Camillo, Torino, Italy.,Degree course of Physiotherapy, Universitá degli Studi di Torino, Torino, Italy
| | | | - Giacinto Luigi Cerone
- Laboratory for the Engineering of the Neuromuscular System, Politecnico of Torino, Torino, Italy.,PoliTo BIO Med Lab, Politecnico di Torino, Torino, Italy
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Taian Vieira
- Laboratory for the Engineering of the Neuromuscular System, Politecnico of Torino, Torino, Italy.,PoliTo BIO Med Lab, Politecnico di Torino, Torino, Italy
| | - Alessio Gallina
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.
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Magel JS, Gordon AJ, Fritz JM, Kim J. The Influence of an Opioid Use Disorder on Initiating Physical Therapy for Low Back Pain: A Retrospective Cohort. J Addict Med 2021; 15:226-232. [PMID: 33074851 PMCID: PMC8050136 DOI: 10.1097/adm.0000000000000751] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Low back pain (LBP) is common among patients with an opioid use disorder (OUD). The extent to which patients with an OUD initiate physical therapy for LBP is unknown. The aim of this study was to examine the association between a history of an OUD and initiation of physical therapy for LBP within 60 days of a primary care provider (PCP) visit for this condition. METHODS Claims from a single state-wide all payer claims database from June 30, 2013 and August 31, 2015 were used to establish a retrospective cohort of patients who consulted a PCP for a new episode of LBP. The outcome measure was patients who had at least 1 physical therapy claim within 60-days after the PCP visit. After propensity score matching on covariates, logistic regression was used to compare the outcome of patients with a history of an OUD to patients without an OUD. RESULTS Propensity score matching resulted in 1360 matched pairs of participants. The mean age was 47.2 years (15.9) and 55.9% were female. Compared to patients without an OUD, patients with an OUD were less likely to initiate physical therapy for LBP (adjusted odds ratio = 0.65, 95% confidence intervals:0.49-0.85). CONCLUSIONS After a visit to a PCP for a new episode of care for LBP, patients with a history of an OUD are less likely to initiate physical therapy.
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Affiliation(s)
- John S Magel
- Department of Physical Therapy and Athletic Training, University of Utah, UT (JSM, JMF, JK); Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA) and Greater Intermountain Node (GIN), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AG)
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Chala MB, Donnelly C, Wondie Y, Ghahari S, Miller J. Cross-cultural translation, adaptation, and validation of the Amharic version pain self-efficacy questionnaire in people with low back pain in Ethiopia. BMC Musculoskelet Disord 2021; 22:111. [PMID: 33494728 PMCID: PMC7836442 DOI: 10.1186/s12891-021-03985-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/19/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Pain Self-Efficacy Questionnaire (PSEQ) is a valid and reliable instrument that evaluates pain self-efficacy beliefs in people with pain conditions. However, it has not been validated and used in Ethiopia. We conducted this study to translate, adapt, and test the psychometric properties of the PSEQ in the Amharic language and Ethiopian context for its use with people experiencing low back pain (LBP). METHODS The PSEQ was translated into Amharic and then back-translated into English. An expert review committee created a final Amharic version of the tool (PSEQ-Am), followed by pilot testing and cognitive debriefing with a sample of 20 people with LBP. The psychometric properties of the final version of PSEQ-Am were assessed in a sample of 240 people with LBP recruited from three rehabilitation centers in Ethiopia. Cronbach's alpha and Intra-class correlation coefficient were calculated to describe the reliability and internal consistency of the tool. The SF-36-Am bodily pain subscale was used to assess convergent validity. Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis (EFA) were performed to determine the dimensionality of the instrument. RESULTS PSEQ-Am demonstrated excellent test-retest reliability (ICC = 0.93) and internal consistency (Cronbach's alpha = 0.91). As hypothesized, the tool demonstrated a significant moderate correlation with the Bodily Pain subscale of the SF-36-Am (Rho = 0.51, p < 0.01). EFA analysis shows that the Amharic version of PSEQ is a dominant one factor and secondary two factor structure. CONCLUSION This study shows that PSEQ-Am is a reliable and valid tool that can be used in both clinical practice and research in the Ethiopian low back pain population.
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Affiliation(s)
- Mulugeta Bayisa Chala
- Queen’s University, School of Rehabilitation Therapy, Kingston, ON Canada
- Department of Physiotherapy, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Catherine Donnelly
- Queen’s University, School of Rehabilitation Therapy, Kingston, ON Canada
| | - Yemataw Wondie
- Department of Psychology, University of Gondar, College of social Sciences and Humanities, Gondar, Ethiopia
| | - Setareh Ghahari
- Queen’s University, School of Rehabilitation Therapy, Kingston, ON Canada
| | - Jordan Miller
- Queen’s University, School of Rehabilitation Therapy, Kingston, ON Canada
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46
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Koerich MHADL, Meirelles BHS, Echevaría-Guanilo ME, Danielewicz AL, Schwertner DS, Knabben RJ. Disability in people with chronic low back pain treated in primary care. FISIOTERAPIA EM MOVIMENTO 2021. [DOI: 10.1590/fm.2021.34121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Low back pain is a common musculoskeletal problem and can become chronic, with varying degrees of disability. Objective: Analyze the factors associated with disability in individuals with chronic low back pain (CLBP), treated in primary care. Methods: Cross-sectional study with 82 basic health unit (BHU) users in the municipality of Florianópolis (Brazil) with CLBP. Sociodemographic and clinical variables, health status, lifestyle and treatment were investigated. Self-rated disability was investigated using the Roland Morris questionnaire (≥ 14 points). The χ2 or Fisher’s exact tests were used in inferential analysis for univariate association and the presence of disability. Multivariate association was analyzed by logistical regression, estimating the crude and adjusted odds ratios (OR) and their respective confidence intervals (95%CI). Results: Adults aged 40-59 years had a greater chance of developing disability (OR: 8.17; 95%: 1.21 - 55.0), while professionally active individuals (OR: 0.08; 95%CI: 0.02 - 0.33) who reported engaging in physical activity ≥ 3 times a week (OR: 0.19; IC95%: 0.04 - 0.83) had less chance of the same outcome when compared to the other participants. Conclusion: Factors related to disability were age, employment status and frequency of physical activity. Incentive strategies to return to work and engage in regular physical activity and exercise should be encouraged.
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47
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Hayward R, Stynes S. Self-efficacy as a prognostic factor and treatment moderator in chronic musculoskeletal pain patients attending pain management programmes: A systematic review. Musculoskeletal Care 2020; 19:278-292. [PMID: 33378591 DOI: 10.1002/msc.1533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Evidence on the effectiveness of pain management programmes (PMPs) for chronic pain patients is mixed. Self-efficacy may be associated with outcome of PMPs. The purpose of this systematic review was to assess the role of self-efficacy as a (i) prognostic factor and (ii) moderator of treatment, in chronic musculoskeletal pain (CMP) patients attending a PMP. METHODS A systematic review of the literature and qualitative synthesis was carried out. Six electronic databases were searched (1989-2020). Studies that measured pain self-efficacy as a prognostic factor or treatment moderator in patients with CMP, who participated in a multidisciplinary PMP were included. Study quality was appraised using the Quality in Prognosis Studies (QUIPS) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Six studies investigating self-efficacy as a prognostic factor were included with a total of 1881 participants. No studies were found assessing self-efficacy as a treatment moderator. Self-efficacy was a prognostic factor for physical functioning in two studies. There was weak evidence for self-efficacy as a prognostic factor for disability, health-related quality of life and pain outcomes and no evidence for psychological variables, disease severity and tender point index following PMPs. Quality of evidence was very low using the GRADE system for each outcome measure. CONCLUSION Baseline self-efficacy may play a role in physical function outcomes in CMP patients attending a PMP. Higher quality evidence is needed to determine the influence of self-efficacy on outcomes in this setting.
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Affiliation(s)
- Rebecca Hayward
- Department of Pain Medicine, North West Anglia NHS Foundation Trust, Stamford and Rutland Hospital, Stamford, Lincolnshire, UK.,School of Allied Health Professions, Keele University, UK
| | - Siobhan Stynes
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK.,Haywood Hospital Interface Service, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
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Stubbs C, Mc Auliffe S, Mallows A, O’sullivan K, Haines T, Malliaras P. The strength of association between psychological factors and clinical outcome in tendinopathy: A systematic review. PLoS One 2020; 15:e0242568. [PMID: 33253233 PMCID: PMC7703922 DOI: 10.1371/journal.pone.0242568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/04/2020] [Indexed: 12/29/2022] Open
Abstract
Objective Tendinopathy is often a disabling, and persistent musculoskeletal disorder. Psychological factors appear to play a role in the perpetuation of symptoms and influence recovery in musculoskeletal pain. To date, the impact of psychological factors on clinical outcome in tendinopathy remains unclear. Therefore, the purpose of this systematic review was to investigate the strength of association between psychological factors and clinical outcome in tendinopathy. Methods A systematic review of the literature and qualitative synthesis of published trials was conducted. Electronic searches of ovid MEDLINE, ovid EMBASE, PsychINFO, CINAHL and Cochrane Library was undertaken from their inception to June 2020. Eligibility criteria included RCT’s and studies of observational design incorporating measurements of psychological factors and pain, disability and physical functional outcomes in people with tendinopathy. Risk of Bias was assessed by two authors using a modified version of the Newcastle Ottawa Scale. High or low certainty evidence was examined using the GRADE criteria. Results Ten studies of observational design (6-cross sectional and 4 prospective studies), involving a sample of 719 participants with tendinopathy were included. Risk of bias for the included studies ranged from 12/21 to 21/21. Cross-sectional studies of low to very low level of certainty evidence revealed significant weak to moderate strength of association (r = 0.24 to 0.53) between psychological factors and clinical outcomes. Prospective baseline data of very low certainty evidence showed weak strength of association between psychological factors and clinical outcome. However, prospective studies were inconsistent in showing a predictive relationship between baseline psychological factors on long-term outcome. Cross sectional studies report similar strengths of association between psychological factors and clinical outcomes in tendinopathy to those found in other musculoskeletal conditions. Conclusion The overall body of the evidence after applying the GRADE criteria was low to very low certainty evidence, due to risk of bias, imprecision and indirectness found across included studies. Future, high quality longitudinal cohort studies are required to investigate the predictive value of baseline psychological factors on long-term clinical outcome.
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Affiliation(s)
- Carl Stubbs
- Sunshine Coast Hospital Health Service, Monash University, Queensland, Australia
| | - Sean Mc Auliffe
- Department of Physical Therapy and Rehabilitation Sciences, College of health Sciences, Qatar University, Doha, Qatar
- * E-mail:
| | - Adrian Mallows
- School of Health and Human Sciences, University of Essex, Colchester, United Kingdom
| | - Kieran O’sullivan
- Department of Allied Health, University of Limerick, Limerick, Ireland
| | - Terence Haines
- Department of Physiotherapy, School of Primary and Allied Health, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
| | - Peter Malliaras
- School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
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Main CJ. Backs in the Future: A Journey Through the Spinal Landscape. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:497-504. [PMID: 32683542 PMCID: PMC7368617 DOI: 10.1007/s10926-020-09913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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50
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Baxter GD, Chapple C, Ellis R, Hill J, Liu L, Mani R, Reid D, Stokes T, Tumilty S. Six things you need to know about low back pain. J Prim Health Care 2020; 12:195-198. [PMID: 32988440 DOI: 10.1071/hc19117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/30/2020] [Indexed: 11/23/2022] Open
Abstract
Low back pain (LBP) is the leading contributor to years lived with disability, and imposes an enormous burden on individuals and on health-care systems. General practitioners and physiotherapists are generally the front-line health professionals dealing with patients with LBP, and have a key role in minimising its effect. Here we review six key issues associated with LBP including its effects, diagnosis and management in primary care, and highlight the importance of the biopsychosocial model and matched care for patients with LBP.
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Affiliation(s)
- G David Baxter
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054, New Zealand; and Corresponding author.
| | - Cathy Chapple
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Richard Ellis
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Julia Hill
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Lizhou Liu
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Duncan Reid
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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