1
|
Keyaerts S, Godderis L, Vanden Abeele V, Daenen L. Identifying pain profiles in employees including work-related factors and pain perceptions: a cross-sectional study in Belgian companies. BMJ Open 2024; 14:e082804. [PMID: 39134443 DOI: 10.1136/bmjopen-2023-082804] [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: 08/21/2024] Open
Abstract
OBJECTIVES Studies usually investigate a limited number or a predefined combinations of risk factors for sickness absence in employees with pain. We examined frequently occurring combinations across a wide range of work-related factors and pain perceptions. DESIGN Cross-sectional study. SETTING Belgian companies that are under supervision of IDEWE, an external service for prevention and protection at work. PARTICIPANTS In total, 249 employees experiencing pain for at least 6 weeks were included and filled out an online survey. OUTCOMES Latent profile analysis was used to differentiate profiles of work-related factors (physical demands, workload, social support and autonomy) and pain perceptions (catastrophising, fear-avoidance beliefs and pain acceptance). Subsequently, profiles were compared on sociodemographics (age, gender, level of education, work arrangement, duration of complaints, multisite pain and sickness absence in the previous year) and predictors of sickness absence (behavioural intention and perceived behavioural control). RESULTS Four profiles were identified. Profile 1 (38.2%) had favourable scores and profile 4 (14.9%) unfavourable scores across all indicators. Profile 2 (33.3%) had relatively high physical demands, moderate autonomy levels and favourable scores on the other indicators. Profile 3 (13.7%) showed relatively low physical demands, moderate autonomy levels, but unfavourable scores on the other indicators. Predictors of profiles were age (OR 0.93 and 95% CI (0.89 to 0.98)), level of education (OR 0.28 and 95% CI (0.1 to 0.79)) and duration of sickness absence in the previous year (OR 2.29 and 95% CI (0.89 to 5.88)). Significant differences were observed in behavioural intention (χ2=8.92, p=0.030) and perceived behavioural control (χ2=12.37, p=0.006) across the four profiles. CONCLUSION This study highlights the significance of considering the interplay between work-related factors and pain perceptions in employees. Unfavourable scores on a single work factor might not translate into maladaptive pain perceptions or subsequent sickness absence, if mitigating factors are in place. Special attention must be devoted to employees dealing with unfavourable working conditions along with maladaptive pain perceptions. In this context, social support emerges as an important factor influencing sickness absence.
Collapse
Affiliation(s)
- Stijn Keyaerts
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Knowledge Information and Research Center, Group Idewe, Leuven, Belgium
| | - Lode Godderis
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Knowledge Information and Research Center, Group Idewe, Leuven, Belgium
| | | | - Liesbeth Daenen
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Knowledge Information and Research Center, Group Idewe, Leuven, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, VU Brussels, Brussels, Belgium
| |
Collapse
|
2
|
Jakobsen MD, Vinstrup J, Andersen LL. Work-Related Fear-Avoidance Beliefs and Risk of Low-Back Pain: Prospective Cohort Study Among Healthcare Workers. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10221-y. [PMID: 39103730 DOI: 10.1007/s10926-024-10221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE Low-back pain (LBP) is a prevalent condition among healthcare workers, negatively affecting well-being and work ability. Research has identified fear-avoidance beliefs, i.e., the belief that physical activities worsen or prolong pain, as a key psychological factor in LBP. Given the physical demands of healthcare work, understanding the link between fear-avoidance and LBP is crucial for effective prevention and management strategies. This study investigated the prospective association between fear-avoidance beliefs and risk of increased LBP intensity and duration in hospital workers. METHODS Fear-avoidance beliefs and LBP were assessed in 1933 healthcare workers from 389 departments at 19 hospitals at baseline and 1-year follow-up. Associations between baseline work-related fear-avoidance beliefs (FABW) and LBP intensity and duration at follow-up were analyzed using cumulative logistic regression, adjusting for various factors including age, sex, baseline LBP, education, seniority, patient transfers, psychosocial work environment, and lifestyle. RESULTS Moderate and high FABW was associated with higher odds of increased pain intensity (OR: 1.37 [95% CI 1.09-1.73] and 1.85 [95% CI 1.18-2.88], respectively) and prolonged pain duration (OR: 1.37 [95% CI 1.05-1.78] and 2.27 [95% CI 1.50-3.44], respectively). A sensitivity analysis including only female nurses showed similar results, with the high FABW group having significantly higher odds of increased pain intensity (OR 2.95, 95% CI 1.84-4.72) and duration (OR 2.64, 95% CI 1.55-4.49). CONCLUSIONS Fear-avoidance beliefs increase the risk of LBP intensity and duration among healthcare workers, emphasizing the need for interventions dealing with psychological aspects of LBP.
Collapse
Affiliation(s)
- Markus Due Jakobsen
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark.
| | - Jonas Vinstrup
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Lars Louis Andersen
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
3
|
Christe G, Benaim C, Jolles BM, Favre J. Changes in spinal motor behaviour are associated with reduction in disability in chronic low back pain: A longitudinal cohort study with 1-year follow-up. Eur J Pain 2024; 28:1116-1126. [PMID: 38299715 DOI: 10.1002/ejp.2245] [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: 08/04/2023] [Revised: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The need to improve spinal motor behaviour in chronic low back pain (CLBP) rehabilitation remains unclear. The objective of this study was to test if changes in spinal motor behaviour were associated with changes in disability after an interdisciplinary rehabilitation program (IRP) in patients with CLBP. METHODS Seventy-one patients with CLBP participating in an IRP were included. Spinal motor behaviour was assessed with biomechanical (lumbar angular amplitude and velocity, erector spinae muscle activity and duration of the task), cognitive-emotional (task-specific fear [PRF]) and pain-related (movement-evoked pain [MEP]) measures during a lifting task before and after the IRP. Disability was measured before and after the IRP, and at 3-month and 1-year follow-ups. RESULTS After adjusting for confounders, changes in disability were significantly associated with MEP changes (β adj. = 0.49, p < 0.001) and PRF changes (β adj. = 0.36, p = 0.008), but not with changes in any of the biomechanical measures. MEP at the end of IRP was also associated with disability at 3 months (β adj. = 0.37, p = 0.001) and 1 year (β adj. = 0.42, p = 0.01). Biomechanical measures at the end of the IRP were not associated with disability, except for the duration of the task that was significantly associated with reduction of disability at 3 months (β non-adj = 0.5, p < 0.001). CONCLUSIONS Pain-related and cognitive-emotional measures of spinal motor behaviour were associated with reduction in disability following an IRP. Future research is needed to further investigate causal relationships between spinal motor behaviour and disability. SIGNIFICANCE STATEMENT This study supports a multidimensional understanding and analysis of spinal motor behaviour, integrating the cognitive-emotional, pain-related and biomechanical domains. It also supports the consideration of spinal motor behaviour as a potentially important treatment target in chronic low back pain management. Moreover, it suggests that reducing movement-evoked pain and task-specific fear may have more influence on disability than changing lumbar amplitude, lumbar angular velocity or erector muscle activity, which may have important implications for rehabilitation.
Collapse
Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charles Benaim
- Department of Physical Medicine and Rehabilitation, Orthopedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Brigitte M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne, Sion, Switzerland
| |
Collapse
|
4
|
IJzelenberg W, Oosterhuis T, Hayden JA, Koes BW, van Tulder MW, Rubinstein SM, de Zoete A. Exercise Therapy for Treatment of Acute Non-specific Low Back Pain: A Cochrane Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2024; 105:1571-1584. [PMID: 38513994 DOI: 10.1016/j.apmr.2024.02.732] [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: 12/04/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To assess the effectiveness of exercise for acute non-specific low back pain (LBP) vs our main comparisons: (1) sham treatment and (2) no treatment at short term (main follow-up time). DATA SOURCES AND STUDY SELECTION A comprehensive search up till November 2021 was conducted in numerous databases for randomized controlled trials on the effectiveness of exercise in adults with acute LBP (<6 weeks). Studies examining LBP with a specific etiology were excluded. The primary outcomes were back pain, back-specific functional status, and recovery. DATA EXTRACTION Two review authors independently conducted the study selection, risk of bias assessment, and data extraction. GRADE was used to assess the certainty of the evidence. DATA SYNTHESIS We identified 23 randomized controlled trials (2674 participants). There is very low-certainty evidence that exercise therapy compared with sham/placebo treatment has no clinically relevant effect on pain (mean difference [MD] -0.80, 95% confidence interval [CI] -5.79 to 4.19; 1 study, 299 participants) and on functional status (MD 2.00, 95% CI -2.20 to 6.20; 1 study, 299 participants) in the short term. There is very low-quality evidence which suggests no difference in effect on pain and functional status for exercise vs no treatment (2 studies; n=157, not pooled due to heterogeneity) at short-term follow-up. Similar results were found for the other follow-up moments. The certainty of the evidence was downgraded because many randomized controlled trials had a high risk of bias, were small in size, and/or there was substantial heterogeneity. CONCLUSION Exercise therapy compared with sham/placebo and no treatment may have no clinically relevant effect on pain or functional status in the short term in people with acute non-specific LBP, but the evidence is very uncertain. Owing to insufficient reporting of adverse events, we were unable to reach any conclusions on the safety or harms related to exercise therapy.
Collapse
Affiliation(s)
- Wilhelmina IJzelenberg
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Teddy Oosterhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Bart W Koes
- Department of General Practice, Erasmus Medical Center, Rotterdam, Netherlands; Center for Muscle and Health, University of Southern Denmark, Odense, Denmark
| | - Maurits W van Tulder
- Department Human Movement Sciences, Faculty Behavioural & Movement Sciences, Vrije Universiteit Amsterdam
| | - Sidney M Rubinstein
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annemarie de Zoete
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
5
|
Makhoul M, Noureddine S, Abu-Saad Huijer H, Farhood L, Fares S, Uthman I, French DJ, France CR. Psychometric Properties of the Arabic Version of the Pain Resilience Scale among Lebanese Adults with Chronic Musculoskeletal Pain. Pain Res Manag 2024; 2024:7361038. [PMID: 39104726 PMCID: PMC11300090 DOI: 10.1155/2024/7361038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/16/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
Background The Pain Resilience Scale (PRS), which measures behavioral perseverance and the ability to regulate emotions and cognition despite ongoing pain, lacks an Arabic version. Objectives This study aimed to translate, culturally adapt, and validate an Arabic version of the Pain Resilience Scale (PRS-A) among Lebanese adults. Methods Phase 1 involved translation and cross-cultural adaptation of the PRS into Arabic. Phase 2 examined the reliability and validity of the PRS-A. A convenience sample of 154 Lebanese adults with chronic musculoskeletal pain completed the PRS-A and self-report measures of pain catastrophizing, pain self-efficacy, pain intensity and interference, depression and anxiety, and quality of life. Results The PRS-A yielded a two-factor structure with factor 1 representing "cognitive/affective positivity" and factor 2 representing "behavioral perseverance," accounting for 41.93% and 15.15% of the variance in pain resilience, respectively. Total PRS-A score (M = 33.20 and SD = 9.90) showed significant correlations with pain catastrophizing (M = 27.65, SD = 13.03, and r = -0.52), pain self-efficacy (median = 9.00, IQR = 4, and rho = 0.61), pain intensity (M = 4.50, SD = 2.25, and r = -0.28), pain interference (M = 4.30, SD = 2.89, and r = -0.56), physical (M = 34.95, SD = 9.52, and r = 0.34) and mental (M = 40.08, SD = 12.49, and r = 0.58) health functioning, anxiety (median = 7.00, IQR = 7, and rho = -0.57), and depression (median = 4.00, IQR = 6, and rho = -0.58). PRS-A subscale was also significantly related to all measures except pain intensity, which was correlated with cognitive/affective positivity (r = -0.33) but not behavioral perseverance (r = -0.09). Cronbach's alpha for the PRS-A was 0.87. Conclusion The PRS-A demonstrated validity and acceptable reliability among Arab-speaking individuals with chronic musculoskeletal pain, suggesting its potential utility for assessing pain resilience within this population.
Collapse
Affiliation(s)
- Melissa Makhoul
- Rafic Hariri School of NursingAmerican University of Beirut, Beirut, Lebanon
| | - Samar Noureddine
- Rafic Hariri School of NursingAmerican University of Beirut, Beirut, Lebanon
| | | | - Laila Farhood
- Rafic Hariri School of NursingAmerican University of Beirut, Beirut, Lebanon
| | - Souha Fares
- Rafic Hariri School of NursingAmerican University of Beirut, Beirut, Lebanon
| | - Imad Uthman
- Department of Internal MedicineAmerican University of Beirut Medical Center, Beirut, Lebanon
| | | | | |
Collapse
|
6
|
Sharif-Nia H, Froelicher ES, Shafighi AH, Osborne JW, Fatehi R, Nowrozi P, Mohammadi B. The persian version of the fear-avoidance beliefs questionnaire among iranian post-surgery patients: a translation and psychometrics. BMC Psychol 2024; 12:390. [PMID: 39010142 PMCID: PMC11247876 DOI: 10.1186/s40359-024-01884-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/02/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION Fear-avoidance beliefs (FAB) play a crucial role in the treatment outcomes of post-surgery patients. These beliefs can lead to activity avoidance, increased pain, and decreased quality of life. Therefore, accurately measuring these beliefs in Iranian patients is of significant importance. The Fear-Avoidance Belief Questionnaire (FABQ) is a patient-reported questionnaire that evaluates individuals' FAB. Since the validity and reliability of the Persian version of FABQ (FABQ-P) have not been assessed based on the Iranian population and sociocultural contexts, the current study has been implemented to determine the reliability and validity of the FABQ-P among Iranian post-operative patients by translation and psychometric properties. METHODS This methodological study conducted in 2023, a sample of 400 patients who had undergone surgery were selected using a convenience sampling method. The scale used in the study was translated and its psychometric properties were evaluated through network analysis and assessments of construct validity (including exploratory and confirmatory factor analysis), convergent validity, and discriminant validity. Additionally, the study assessed the internal consistency of the scale. RESULTS The MLEFA results with Promax and Kaiser Normalization rotation yielded two factors explaining 57.91% of the variance, encompassing 13 items. Also, the model was approved by CFA. Convergent and discriminant validity have been confirmed through the following criteria: Average Variance Extracted (AVE) exceeding 0.5, Composite Reliability (CR) surpassing 0.7, and Heterotrait-Monotrait Ratio of Correlations (HTMT) equating to 0.597. As for reliability, Cronbach's alpha, composite reliability (CR), and MaxR for all constructs were greater than 0.7, demonstrating good internal consistency. CONCLUSION As demonstrated by the results, the FABQ-P has a satisfactory level of reliability along with authentic validity according to the sociocultural contexts of Iranian post-operative patients.
Collapse
Affiliation(s)
- Hamid Sharif-Nia
- Psychosomatic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing, Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Amir Hossein Shafighi
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran.
| | | | - Reza Fatehi
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Poorya Nowrozi
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Bita Mohammadi
- Master of Nursing, Hospital Nurse 17 Shahrivar Amol, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
7
|
Newton C, Singh G, Nolan D, Booth V, Diver C, O'Neill S, Purtill H, Logan P, O'Sullivan K, O'Sullivan P. Cognitive Functional Therapy compared with usual physiotherapy care in people with persistent low back pain: a mixed methods feasibility randomised controlled trial in the United Kingdom National Health Service. Physiotherapy 2024; 123:118-132. [PMID: 38479068 DOI: 10.1016/j.physio.2024.02.003] [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: 12/15/2022] [Revised: 12/12/2023] [Accepted: 02/06/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To determine the feasibility of completing a definitive randomised controlled trial (RCT), evaluating the clinical and cost-effectiveness of Cognitive Functional Therapy (CFT) in comparison to usual physiotherapy care (UPC), for people with persistent low back pain (LBP). DESIGN AND SETTING A two-arm parallel feasibility RCT completed in a United Kingdom (UK) Secondary Care National Health Service (NHS) physiotherapy service. PARTICIPANTS Sixty adult participants who reported LBP lasting for more than three months, that was not attributable to a serious (e.g. cancer) or specific (e.g. radiculopathy) underlying cause, were invited to participate. Participants were allocated at random to receive CFT or UPC. INTERVENTIONS Cognitive Functional Therapy and Usual Physiotherapy Care for persistent LBP. MAIN OUTCOME MEASURES The primary outcome was the feasibility of completing a definitive RCT, defined by recruitment of at least 5 participants per month, delivery of CFT per protocol and securing relevant and acceptable outcome measures. Data concerning study processes, resources, management and participant reported outcome measures were collected at baseline, 3, 6 and 12-month follow-up. RESULTS Sixty participants (n = 30 CFT and n = 30 UPC) were recruited with 80% (n = 48), 72% (n = 43) and 53% (n = 32) retained at 3, 6 and 12-month follow-up respectively. NHS physiotherapists were trained to competence and delivered CFT with fidelity. CFT was tolerated by participants with no adverse events. Relevant and clinically important outcome data were collected at all time points (0.4%, 3%, 1% and 0.8% of data was missing from the returned outcome measure booklets at baseline and 3, 6 and 12-month follow-up respectively). The Roland-Morris disability questionnaire was considered the most suitable primary outcome measure with a proposed sample size of 540 participants for a definitive cluster RCT. CONCLUSION It is feasible to conduct a randomised study of CFT in comparison to UPC for NHS patients. A future study should incorporate an internal pilot to address aspects of feasibility further, including participant retention strategies. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN12965286 CONTRIBUTION OF THE PAPER.
Collapse
Affiliation(s)
- Christopher Newton
- Centre of Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, UK; Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Gurpreet Singh
- Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David Nolan
- Physiotherapy Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Vicky Booth
- Centre of Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, UK
| | - Claire Diver
- Centre of Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, UK
| | - Seth O'Neill
- School of Allied Health Professions, College of Life Sciences, University of Leicester, Leicester, UK
| | - Helen Purtill
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Pip Logan
- Centre of Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, UK
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland; Ageing Research Centre, University of Limerick, Limerick, Ireland; Sports and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| |
Collapse
|
8
|
Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. Examining Psychological Factors as Contributors to Pain, Disability, and Physical Function in Geriatric Chronic Low Back Pain: A Prospective Analysis of the Delaware Spine Studies Cohort. THE JOURNAL OF PAIN 2024; 25:104448. [PMID: 38122878 PMCID: PMC11128354 DOI: 10.1016/j.jpain.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
In younger populations, risk factors from psychologically-focused theoretical models have become accepted as primary drivers behind the persistence of low back pain (LBP), but these risk factors have not been thoroughly assessed in older adult populations (60-85 years). To address this knowledge gap, we sought to examine longitudinal associations between both general and pain-related psychological risk factors and future pain intensity, LBP-related disability, and physical function (gait speed) outcomes in older adults with chronic LBP (n = 250). Questionnaires for general (ie, depressive symptoms) and pain-related psychological risk factors (ie, fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were collected at baseline. Questionnaire values were entered into principal component analysis to yield a combined psychological component score. LBP intensity (pain thermometers), LBP-related disability (Quebec Back Pain Disability Scale), and gait speed were measured at baseline and 12-month follow-up. Multiple linear regression was used to examine adjusted associations between baseline psychological component scores and each prospective outcome. The baseline psychological component score failed to independently predict 12-month LBP-related disability and gait speed after adjustment for baseline outcomes. Though the psychological component score was associated with 12-month LBP intensity after adjusting for baseline LBP intensity, this association diminished with full adjustment for other baseline characteristics. Cumulatively, general and pain-related psychological risk factors did not independently predict longitudinal pain, disability, and physical function outcomes in this cohort. Compared to younger populations with this condition, general and pain-related psychological risk factors may have less influence on the maintenance of chronic LBP in older adults. PERSPECTIVE: This article failed to establish consistent independent relationships between psychological factors and worse longitudinal pain, disability, and physical function outcomes in older adults with chronic LBP. The findings highlight a need to determine other age-specific biopsychosocial risk factors that may impact the maintenance of chronic pain in this patient population.
Collapse
Affiliation(s)
- Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, NC
| | - Ryan T. Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE
- Biostatistics Core, University of Delaware, Newark, DE
| | | | - Peter C. Coyle
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Jaclyn M. Sions
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
| |
Collapse
|
9
|
Ahn SE, Lee MY, Lee BH. Effects of Gluteal Muscle Strengthening Exercise-Based Core Stabilization Training on Pain and Quality of Life in Patients with Chronic Low Back Pain. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:849. [PMID: 38929466 PMCID: PMC11205821 DOI: 10.3390/medicina60060849] [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: 04/02/2024] [Revised: 05/02/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
Background: The World Health Organization reports that back pain is a major cause of disorder worldwide. It is the most common musculoskeletal disorder with limited pain, muscle tension, and stiffness, and 70-80% of all individuals experience it once in their lifetime, with higher prevalence in women than in men. This study aimed to investigate the effects of gluteal muscle strengthening exercise- based core stabilization training (GSE-based CST) on pain, function, fear-avoidance patterns, and quality of life in patients with chronic back pain. Methods: This study included 34 patients with non-specific chronic low back pain. Seventeen individuals each were included in GSE-based CST and control groups. The GSE-based CST group performed GSE and CST for 15 min, three times a week for four weeks, and the control group performed CST for 30 min a day, three times a week for four weeks. The numeric pain rating scale was used to evaluate pain before and after treatment, Roland-Morris disability questionnaire was used to evaluate function, fear-avoidance beliefs questionnaire was used to evaluate fear-avoidance patterns, and quality of life was measured using the short form-36. Results: In this study, pain, function, and fear-avoidance pattern decreased significantly in both groups (All p < 0.05). During the evaluation of quality of life, both groups showed significant increase in physical and mental factors (p < 0.05). There were significant differences in pain and quality of life (p < 0.05) between the GSE-based CST and control groups. Conclusions: Therefore, GSE-based CST can be used as a basis for effective intervention to enhance pain, function, fear-avoidance patterns, and quality of life, emphasizing the need for gluteal muscle strengthening exercises in patients with non-specific chronic back pain in the future.
Collapse
Affiliation(s)
- Seung-Eon Ahn
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea;
| | - Mi-Young Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea;
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea;
| |
Collapse
|
10
|
Kissi A, Vorensky M, Sturgeon JA, Vervoort T, van Alboom I, Guck A, Perera RA, Rao S, Trost Z. Racial Differences in Movement-Related Appraisals and Pain Behaviors Among Adults With Chronic Low Back Pain. THE JOURNAL OF PAIN 2024; 25:104438. [PMID: 38065466 PMCID: PMC11058036 DOI: 10.1016/j.jpain.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
Research documents racial disparities in chronic low back pain (CLBP). Few studies have examined racial disparities in movement-related appraisals and no studies have examined anticipatory appraisals prior to or pain behaviors during functional activities among individuals with CLBP. This cross-sectional study examined racial differences in anticipatory appraisals of pain, concerns about harm, and anxiety, appraisals of pain and anxiety during movement, and observed pain behaviors during 3 activities of daily living (supine-to-standing bed task, sitting-to-standing chair task, floor-to-waist lifting task) in a sample (N = 126) of non-Hispanic Black (31.0%), Hispanic (30.2%), and non-Hispanic White (38.9%) individuals with CLBP. Hispanic participants reported more expected pain, concerns about harm, and pre-movement anxiety prior to the bed and chair tasks compared to non-Hispanic White participants. Hispanic participants reported more pain during the bed task and more anxiety during the bed and chair tasks compared to non-Hispanic White participants. Non-Hispanic Black participants reported more expected pain, concerns about harm, and pre-movement anxiety prior to the bed task and more pre-movement anxiety prior to the chair task compared to non-Hispanic White participants. Non-Hispanic Black participants reported more anxiety during the bed and chair tasks compared to non-Hispanic White participants. Non-Hispanic Black participants were observed to have significantly more verbalizations of pain during the bed task compared to non-Hispanic White participants. Current findings identify racial disparities in important cognitive-behavioral and fear-avoidance mechanisms of pain. Results indicate a need to revisit traditional theoretical and treatment models in CLBP, ensuring racial disparities in pain cognitions are considered. PERSPECTIVE: This study examined racial disparities in anticipatory and movement-related appraisals, and pain behaviors during activities of daily living among Non-Hispanic Black, Non-Hispanic White, and Hispanic individuals with CLBP. Racial disparities identified in the current study have potentially important theoretical implications surrounding cognitive-behavioral and fear-avoidance mechanisms of pain.
Collapse
Affiliation(s)
- Ama Kissi
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Mark Vorensky
- Rusk Rehabilitation, NYU Langone Health, 333 East 38 Street, New York, NY 10016, United States of America
- Department of Physical Therapy, New York University, 380 2 Ave, New York, NY 10010, United States of America
- Department of Physical Therapy, Touro University, 3 Times Square, New York, NY 10036, United States of America
| | - John A. Sturgeon
- Department of Anesthesiology, University of Michigan, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48105, United States of America
| | - Tine Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Ischa van Alboom
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Adam Guck
- Department of Family Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, United States of America
| | - Robert A. Perera
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 1223 E Marshall St, Richmond, VA 23298, United States of America
| | - Smita Rao
- Department of Physical Therapy, New York University, 380 2 Ave, New York, NY 10010, United States of America
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 1223 E Marshall St, Richmond, VA 23298, United States of America
| |
Collapse
|
11
|
Igwesi-Chidobe CN, Ifeanyichukwu CN, Okorie JP, Faisal M, Ozumba BC. Prevalence and Biopsychosocial Factors Associated With a Current Episode of Low Back Pain Among Adults With a Previous History of Low Back Pain: A Cross-sectional Study of Market Traders in an African Population. THE JOURNAL OF PAIN 2024:104526. [PMID: 38599267 DOI: 10.1016/j.jpain.2024.104526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 03/12/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
Low back pain (LBP) is the leading cause of years lived with disability globally, with Nigeria having one of the greatest burdens. A current episode of LBP is important in Nigeria, but the associated factors are unknown. This cross-sectional study investigated the prevalence, biomechanical, and psychosocial factors associated with a current episode of LBP among 700 adult market traders with previous LBP in an urban Nigerian population. Descriptive, bivariate, and multivariate analyses were conducted. The prevalence of a current episode of LBP was 76.4%. Factors associated with an increased risk of a current episode of LBP in a decreasing order of importance were exposure to biomechanical factors (aggregate [total] score) (odds ratio [OR] = 1.535; 95% confidence interval [CI] = 1.398-1.685); anxiety (OR = 1.182; 95% CI = 1.089-1.282); fear-avoidance beliefs (physical activity) (OR = 1.139; 95% CI = 1.029-1.261); fear-avoidance beliefs (work) (OR = 1.105; 95% CI = 1.047-1.165); while factors associated with a reduced risk of a current episode of LBP were ability to take breaks in the job in addition to scheduled breaks (OR = .430; 95% CI = .240-.773) and ability to control the order and pace of tasks (OR = .477; 95% CI = .236-.965). Occupational biomechanical and psychosocial factors were associated with a current episode of LBP in logistic regression models explaining 52.7% and 73.1% of the variation in a current episode of LBP. Occupational biomechanical factors, particularly handling large and bulky objects at arm's length and kneeling and squatting, produced the greatest risk of a current episode of LBP. PERSPECTIVE: Occupational biomechanical factors, occupational psychosocial factors, and personal psychosocial factors such as anxiety and fear-avoidance beliefs are associated with a current episode of LBP in Nigeria. Pragmatic public health and occupational health initiatives that modify exposure to these factors may be required in Nigeria.
Collapse
Affiliation(s)
- Chinonso Nwamaka Igwesi-Chidobe
- School of Allied Health Professions and Midwifery, Faculty of Health Studies, University of Bradford, Bradford, United Kingdom; Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria.
| | | | - Joshua P Okorie
- Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
| | - Muhammad Faisal
- Biostatistics Unit, Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
| | - Benjamin C Ozumba
- Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria; Faculty of Medicine, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| |
Collapse
|
12
|
Tieppo Francio V, Alm J, Leavitt L, Mok D, Yoon BV, Nazir N, Lam C, Latif U, Sowder T, Braun E, Sack A, Khan T, Sayed D. Variables associated with nonresponders to high-frequency (10 kHz) spinal cord stimulation. Pain Pract 2024; 24:584-599. [PMID: 38078593 DOI: 10.1111/papr.13328] [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] [Indexed: 04/09/2024]
Abstract
INTRODUCTION The use of spinal cord stimulation (SCS) therapy to treat chronic pain continues to rise. Optimal patient selection remains one of the most important factors for SCS success. However, despite increased utilization and the existence of general indications, predicting which patients will benefit from neuromodulation remains one of the main challenges for this therapy. Therefore, this study aims to identify the variables that may correlate with nonresponders to high-frequency (10 kHz) SCS to distinguish the subset of patients less likely to benefit from this intervention. MATERIALS AND METHODS This was a retrospective single-center observational study of patients who underwent 10 kHz SCS implant. Patients were divided into nonresponders and responders groups. Demographic data and clinical outcomes were collected at baseline and statistical analysis was performed for all continuous and categorical variables between the two groups to calculate statistically significant differences. RESULTS The study population comprised of 237 patients, of which 67.51% were responders and 32.49% were nonresponders. There was a statistically significant difference of high levels of kinesiophobia, high self-perceived disability, greater pain intensity, and clinically relevant pain catastrophizing at baseline in the nonresponders compared to the responders. A few variables deemed potentially relevant, such as age, gender, history of spinal surgery, diabetes, alcohol use, tobacco use, psychiatric illness, and opioid utilization at baseline were not statistically significant. CONCLUSION Our study is the first in the neuromodulation literature to raise awareness to the association of high levels of kinesiophobia preoperatively in nonresponders to 10 kHz SCS therapy. We also found statistically significant differences with greater pain intensity, higher self-perceived disability, and clinically relevant pain catastrophizing at baseline in the nonresponders relative to responders. It may be appropriate to screen for these factors preoperatively to identify patients who are less likely to respond to SCS. If these modifiable risk factors are present, it might be prudent to consider a pre-rehabilitation program with pain neuroscience education to address these factors prior to SCS therapy, to enhance successful outcomes in neuromodulation.
Collapse
Affiliation(s)
- Vinicius Tieppo Francio
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - John Alm
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Logan Leavitt
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Daniel Mok
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - B Victor Yoon
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Niaman Nazir
- Department of Population Health, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Christopher Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Usman Latif
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Timothy Sowder
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Edward Braun
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrew Sack
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Talal Khan
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
13
|
Núñez-Cortés R, Espin A, Pérez-Alenda S, López-Bueno R, Cruz-Montecinos C, Vincents-Seeberg KG, Püschel TA, Calatayud J, Andersen LL. Association Between Pain Coping and Symptoms of Anxiety and Depression, and Work Absenteeism in People With Upper Limb Musculoskeletal Disorders: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:781-791. [PMID: 37490961 DOI: 10.1016/j.apmr.2023.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/02/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To determine the prospective association of pain coping strategies and symptoms of anxiety and depression with work absenteeism in people with upper limb musculoskeletal disorders. DATA SOURCES A systematic search of PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases was conducted from inception to September 23, 2022. STUDY SELECTION Prospective observational studies of adults with upper limb musculoskeletal disorders were included. Included studies had to provide data on the association of pain coping strategies (catastrophizing, kinesiophobia, self-efficacy or fear avoidance) or symptoms of anxiety and depression with work absenteeism. DATA EXTRACTION Study selection, data extraction, and assessment of methodological quality (Newcastle Ottawa Scale) were performed by 2 independent authors. Random-effects models were used for quantitative synthesis. DATA SYNTHESIS Eighteen studies (n=12,393 participants) were included. Most studies (77.8%) reported at least 1 significant association between 1 or more exposure factors (pain coping strategies or symptoms of anxiety and depression) and work absenteeism. Meta-analyses showed a statistically significant correlation between the exposure factors of catastrophizing (r=0.28, 95% confidence interval [CI]: 0.15 to 0.40; P<.0001) and symptoms of anxiety and depression (r=0.23, 95% CI: 0.10 to 0.34; P=.0003) with work absenteeism. The correlation between self-efficacy and work absenteeism was non-significant (r=0.24, 95% CI: -0.02 to 0.47; P=.0747). CONCLUSIONS Rehabilitation teams should consider assessing catastrophizing and symptoms of anxiety and depression to identify patients at risk for work absenteeism. Addressing these variables may also be considered in return-to-work programs for individuals with upper limb disorders.
Collapse
Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ander Espin
- National Research Centre for the Working Environment, Copenhagen, Denmark; Ageing On Research Group, Department of Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Rubén López-Bueno
- National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain; Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Division of Research, Development and Innovation in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | | | - Thomas A Püschel
- Ecology and Evolutionary Biology Division, School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - Joaquín Calatayud
- National Research Centre for the Working Environment, Copenhagen, Denmark; Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain.
| | | |
Collapse
|
14
|
Marciniak T, Kruk-Majtyka W, Bobowik P, Marszałek S. The Relationship between Kinesiophobia, Emotional State, Functional State and Chronic Pain in Subjects with/without Temporomandibular Disorders. J Clin Med 2024; 13:848. [PMID: 38337542 PMCID: PMC10856771 DOI: 10.3390/jcm13030848] [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: 12/20/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Although there is growing evidence that kinesiophobia is correlated with temporomandibular disorders (TMD), its relationship with other characteristic TMD comorbidities, such as depression, anxiety, functional limitations, and pain in the TMD population, has rarely been investigated. This study aims to evaluate the relationship between kinesiophobia, emotional state, functional state and chronic pain in subjects both with and without TMD. A total of 94 subjects participated in the study and were divided into two groups (47 subjects each)-TMD (subjects with temporomandibular disorders) and nTMD (asymptomatic controls)-on the basis of the RDC/TMD protocol. All measurements were taken with self-administered questionnaires: TSK-TMD for kinesiophobia, PHQ-9 and GAD-7 for psychoemotional state, JFLS-20 for jaw functional limitations, and GCPS for chronic pain. The prevalence of kinesiophobia in the TMD group was 38.3% for moderate risk, and 61.7% for high risk. The TMD group showed significantly higher scores in all categories (kinesiophobia, depression, jaw functional limitations and chronic pain), with the exception of anxiety which was right at the cut-off point. Moreover, a significant correlation was found between kinesiophobia (TSK-TMD) and jaw functional limitations (JFLS-20). Results of this study could provide new insight into the relationship between kinesiophobia and TMD, further improving the diagnosis process.
Collapse
Affiliation(s)
- Tomasz Marciniak
- Faculty of Rehabilitation, Józef Piłsudski Academy of Physical Education in Warsaw, 00-968 Warsaw, Poland; (W.K.-M.); (P.B.)
| | - Weronika Kruk-Majtyka
- Faculty of Rehabilitation, Józef Piłsudski Academy of Physical Education in Warsaw, 00-968 Warsaw, Poland; (W.K.-M.); (P.B.)
| | - Patrycja Bobowik
- Faculty of Rehabilitation, Józef Piłsudski Academy of Physical Education in Warsaw, 00-968 Warsaw, Poland; (W.K.-M.); (P.B.)
| | - Sławomir Marszałek
- Department of Physiotherapy, Poznan University of Medical Sciences, 61-701 Poznan, Poland
- Faculty of Physical Education in Gorzow Wielkopolski, Poznan University of Physical Education, 61-871 Poznan, Poland
| |
Collapse
|
15
|
Osuka S, Koshino Y, Watanabe K, Kataoka Y, Tohyama H. Fear-Avoidance Beliefs Associated with Non-Specific Chronic Low Back Pain in College Athletes. J Pain Res 2024; 17:285-292. [PMID: 38268733 PMCID: PMC10807266 DOI: 10.2147/jpr.s447121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Purpose This study aimed to determine the psychosocial factors associated with non-specific chronic low back pain (NS-CLBP) among college athletes. Material and Methods A cross-sectional study was performed at one university. A non-anonymous, self-administered online questionnaire was collected from each athlete. Participants with a history of orthopaedic spine disease or surgery were excluded. Online responses from 368 college athletes belonging to 18 clubs were collected, among which 263 were included in the analysis. In the 263 responses, 41 individuals were identified as having NS-CLBP. Multivariate logistic regression analyses were performed to determine factors associated with presence of NS-CLBP. Independent variables included the Fear-Avoidance Beliefs Questionnaire physical activity subscale (FABQ-PA) score, Tampa Scale for Kinesiophobia-11 (TSK-11) score, Roland-Morris Disability Questionnaire (RDQ) score, and body mass index (BMI). Additionally, the Mann-Whitney U-test was utilized to compare FABQ-PA, TSK-11, RDQ scores, and BMI between the NS-CLBP and non-NS-CLBP groups. Results The FABQ-PA (odd ratio = 1.096, P = 0.003) was significantly associated with NS-CLBP. No significant association was observed between NS-CLBP and TSK-11 (P = 0.776), RDQ (P = 0.074), and BMI (P = 0.296). The scores for FABQ-PA, TSK-11, RDQ, and BMI in the group with NS-CLBP were found to be significantly higher compared to the group without NS-CLBP (P < 0.001, P = 0.034, P < 0.001, and P = 0.022, respectively). Conclusion The present study revealed a significant relationship between higher FABQ-PA scores and NS-CLBP among college athletes. Conversely, TSK-11 and BMI values showed no significant association with NS-CLBP presence. The findings suggest that addressing fear-avoidance beliefs may be crucial in managing NS-CLBP among college athletes.
Collapse
Affiliation(s)
- Satoshi Osuka
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kentaro Watanabe
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Yoshiaki Kataoka
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Harukazu Tohyama
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| |
Collapse
|
16
|
Gerdle B, Dragioti E, Rivano Fischer M, Ringqvist Å. Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up: A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Pain Res 2024; 17:83-105. [PMID: 38196970 PMCID: PMC10775695 DOI: 10.2147/jpr.s438260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024] Open
Abstract
Background Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies. Aim This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator. Methods This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008-2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims. Results Changes in acceptance (β:0.424-0.553; all P<0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (β: 0.177-0.233; all P<0.001) and changes in fear-avoidance (β: -0.152- -0.186; all P<0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator. Discussion and Conclusion Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.
Collapse
Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
17
|
Elabd AM, Elabd OM. Effect of aerobic exercises on patients with chronic mechanical low back pain: A randomized controlled clinical trial. J Bodyw Mov Ther 2024; 37:379-385. [PMID: 38432832 DOI: 10.1016/j.jbmt.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/05/2023] [Accepted: 12/10/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Chronic mechanical low back pain (CMLBP) is one of the most prevalent and costly disorders. Determining its most effective treatment approach is a priority for researchers. PURPOSE To examine the effects of including aerobic exercise within a conventional therapy regimen for young adults with CMLBP. METHODS Fifty CMLBP patients (22 males and 28 females) were randomly and equally assigned to one of two groups to receive the prescribed treatment for 8 weeks. The control group received the traditional program only (infrared, ultrasound, burst TENS, and exercises); for the experimental group, an aerobic training program using a stationary bicycle was added. Back pain intensity was the primary outcome. Secondary outcomes included the Oswestry disability index, back extensor endurance measured by the Sorensen test, and physical performance indicated by the back performance scale and the 6-min walk test. A Two-way MANOVA was used for data analysis. RESULTS Multivariate tests revealed statistically significant effects of group (p = 0.002, partial η2 = 0.182), time (p < 0.001, partial η2 = 0.928), and group-by-time interaction (p = 0.01, partial η2 = 0.149). Univariate group-by-time interactions were significant for back disability (p = 0.043), extensor endurance (p = 0.023) and results of the 6-min walk test (p = 0.023) showing greater improvement in the experimental group. However, back pain intensity and the back performance scale revealed no significant group-by-time interactions. Within-group comparisons were significant for all measured variables in both groups (p < 0.001). CONCLUSION Although a traditional program of infrared, ultrasound, TENS, and exercises is beneficial for CMLBP treatment, adding aerobic exercises to the program leads to more beneficial outcomes.
Collapse
Affiliation(s)
- Aliaa M Elabd
- Basic Science Department, Faculty of Physical Therapy, Benha University, Egypt; Basic Science Department, Faculty of Physical Therapy, Pharos University in Alexandria, Egypt.
| | - Omar M Elabd
- Department of Physical Therapy for Musculoskeletal Disorders, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt; Department of Physical Therapy, Aqaba University of Technology, Aqaba, Jordan
| |
Collapse
|
18
|
Murray FS, Costa N, Jesus-Moraleida F, Meziat-Filho N. What are Brazilian orthopaedists' views on the diagnosis and treatment of patients with chronic nonspecific low back pain? A qualitative investigation. Musculoskeletal Care 2023; 21:1036-1044. [PMID: 37193917 DOI: 10.1002/msc.1778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Orthopaedists are often the first point of contact for patients who present with low back pain (LBP) and chronic LBP in Brazil. AIM To explore the views of orthopaedists on therapeutic approaches for chronic non-specific low back pain (CNLBP) with a view to gain insights into aspects of clinical practice considered important to them. METHODS A qualitative design underpinned by interpretivism was employed. Participants were (n = 13) orthopaedists with experience in treating patients with CNLBP. Following the pilot interviews, semi-structured interviews were conducted, audio-recorded, transcribed and de-identified. Interview data were thematically analysed. RESULTS Four themes were identified. (1) Biophysical aspects are important and predominate, but sometimes their relevance can be unclear; (2) Psychosocial aspects and lifestyle factors influence the therapeutic approach; (3) Treatment of CNLBP - including medication, physical activity, surgery and other invasive procedures and other therapeutic modalities; and (4) Nuances of clinical practice - "it goes beyond medicine". CONCLUSION Brazilian orthopaedists value identifying the biophysical cause(s) of chronic low back pain. Psychological factors were often discussed secondary to biophysical aspects, whereas social aspects were rarely mentioned. Orthopaedists highlighted their difficulties in navigating patients' emotions and reassuring patients without referrals to imaging tests. Orthopaedists may benefit from training that targets communication and other relational aspects of care in order to work with people who present with CNLBP.
Collapse
Affiliation(s)
- Fabiana Silveira Murray
- Centro Universitário Augusto Motta - UNISUAM, Postgraduate Program in Rehabilitation Sciences, Rio de Janeiro, Brazil
| | - Nathalia Costa
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Fabianna Jesus-Moraleida
- Graduate Program in Physiotherapy and Functioning, Department of Physiotherapy, Federal University of Ceará, Fortaleza, Brazil
| | - Ney Meziat-Filho
- Centro Universitário Augusto Motta - UNISUAM, Postgraduate Program in Rehabilitation Sciences, Rio de Janeiro, Brazil
| |
Collapse
|
19
|
Lotz JC, Ropella G, Anderson P, Yang Q, Hedderich MA, Bailey J, Hunt CA. An exploration of knowledge-organizing technologies to advance transdisciplinary back pain research. JOR Spine 2023; 6:e1300. [PMID: 38156063 PMCID: PMC10751978 DOI: 10.1002/jsp2.1300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/02/2023] [Accepted: 10/29/2023] [Indexed: 12/30/2023] Open
Abstract
Chronic low back pain (LBP) is influenced by a broad spectrum of patient-specific factors as codified in domains of the biopsychosocial model (BSM). Operationalizing the BSM into research and clinical care is challenging because most investigators work in silos that concentrate on only one or two BSM domains. Furthermore, the expanding, multidisciplinary nature of BSM research creates practical limitations as to how individual investigators integrate current data into their processes of generating impactful hypotheses. The rapidly advancing field of artificial intelligence (AI) is providing new tools for organizing knowledge, but the practical aspects for how AI may advance LBP research and clinical are beginning to be explored. The goals of the work presented here are to: (1) explore the current capabilities of knowledge integration technologies (large language models (LLM), similarity graphs (SGs), and knowledge graphs (KGs)) to synthesize biomedical literature and depict multimodal relationships reflected in the BSM, and; (2) highlight limitations, implementation details, and future areas of research to improve performance. We demonstrate preliminary evidence that LLMs, like GPT-3, may be useful in helping scientists analyze and distinguish cLBP publications across multiple BSM domains and determine the degree to which the literature supports or contradicts emergent hypotheses. We show that SG representations and KGs enable exploring LBP's literature in novel ways, possibly providing, trans-disciplinary perspectives or insights that are currently difficult, if not infeasible to achieve. The SG approach is automated, simple, and inexpensive to execute, and thereby may be useful for early-phase literature and narrative explorations beyond one's areas of expertise. Likewise, we show that KGs can be constructed using automated pipelines, queried to provide semantic information, and analyzed to explore trans-domain linkages. The examples presented support the feasibility for LBP-tailored AI protocols to organize knowledge and support developing and refining trans-domain hypotheses.
Collapse
Affiliation(s)
- Jeffrey C. Lotz
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | | | - Paul Anderson
- Department of Computer Science & Software EngineeringCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Qian Yang
- Department of Information ScienceCornell UniversityIthacaNew YorkUSA
| | | | - Jeannie Bailey
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | - C. Anthony Hunt
- Department of Bioengineering & Therapeutic SciencesUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| |
Collapse
|
20
|
Liu R, Liu Q, Xu S, Mei R. Mood instability and low back pain: a mendelian randomization study. Front Neurol 2023; 14:1252329. [PMID: 37786864 PMCID: PMC10541504 DOI: 10.3389/fneur.2023.1252329] [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: 07/04/2023] [Accepted: 08/29/2023] [Indexed: 10/04/2023] Open
Abstract
Objective Low back pain is a prevalent and debilitating condition worldwide, with significant implications for individuals' quality of life and productivity. The aim of this study was to assess the relationship between mood instability and the risk of developing chronic low back pain, using a rigorously designed mendelian randomization methodology. Method The study incorporated both univariate and multivariate mendelian randomization to analysis the causal relationship between mood instability and the risk of developing chronic low back pain. The data on mood instability from the Integrative Epidemiology Unit (IEU) opened Genome-Wide Association Studies (GWAS) project (IEU-opened GWAS project). Data on low back pain were collected from two sources: One source is the IEU open GWAS project (discovery data). Another source is a GWAS meta-analysis (replication data). Inverse variance weighted method, weighted median method, MR-Egger regression, and mendelian randomization pleiotropy residual sum and outlier method were used for mendelian randomization analysis. Result The univariable mendelian randomization analysis shows a statistically significant correlation between mood instability and the risk of low back pain. Several methods were performed, including inverse variance weighting (discovery data: odds ratio = 3.544, 95% confidence interval = 1.785-7.039, p = 0.000; replication data: odds ratio = 3.167, 95% confidence interval = 2.476-4.052, p = 0.000), MR-Egger (discovery data: odds ratio = 7.178, 95% confidence interval = 0.057-909.525, p = 0.429; replication data: odds ratio = 2.262, 95% confidence interval = 0.580-8.825, p = 0.246), weighted median (discovery data: odds ratio = 2.730, 95% confidence interval = 1.112-6.702, p = 0.028; replication data: odds ratio = 3.243, 95% confidence interval = 2.378-4.422, p = 0.000), MR-PRESSO (discovery data: odds ratio = 3.544, 95% confidence interval = 1.785-7.039, p = 0.001; replication data: odds ratio = 3.167, 95% confidence interval = 2.476-4.052, p = 0.000) methods. The results were consistent across these methods. The results obtained from discovery data are consistent with those obtained from discovery data. In the multivariable mendelian randomization, after adjusting for various covariates such as body mass index, current tobacco smoking, alcohol intake frequency, Total body bone mineral density, and vigorous physical activity, there is a consistent correlation between mood instability and chronic low back pain. Conclusion This study provides robust evidence supporting a causal relationship between mood instability and the development of low back pain. Our findings suggest that addressing mood instability may play a crucial role in prevention and management strategies for individuals experiencing low back pain.
Collapse
Affiliation(s)
- Renyang Liu
- Department of Orthopaedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Qian Liu
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Shaoyong Xu
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Rongcheng Mei
- Department of Orthopaedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| |
Collapse
|
21
|
Jermini-Gianinazzi I, Blum M, Trachsel M, Trippolini MA, Tochtermann N, Rimensberger C, Liechti FD, Wertli MM. Management of acute non-specific low back pain in the emergency department: do emergency physicians follow the guidelines? Results of a cross-sectional survey. BMJ Open 2023; 13:e071893. [PMID: 37541755 PMCID: PMC10407374 DOI: 10.1136/bmjopen-2023-071893] [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: 01/20/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES Clinical guidelines for acute non-specific low back pain (LBP) recommend avoiding imaging studies or invasive treatments and to advise patients to stay active. The aim of this study was to evaluate the management of acute non-specific LBP in the emergency departments (ED). SETTING We invited all department chiefs of Swiss EDs and their physician staff to participate in a web-based survey using two clinical case vignettes of patients with acute non-specific LBP presenting to an ED. In both cases, no neurological deficits or red flags were present. Guideline adherence and low-value care was defined based on current guideline recommendations. RESULTS In total, 263 ED physicians completed at least one vignette, while 212 completed both vignettes (43% residents, 32% senior/attending physicians and 24% chief physicians). MRI was considered in 31% in vignette 1 and 65% in vignette 2. For pain management, non-steroidal anti-inflammatory drugs, paracetamol and metamizole were mostly used. A substantial proportion of ED physicians considered treatments with questionable benefit and/or increased risk for adverse events such as oral steroids (vignette 1, 12% and vignette 2, 19%), muscle relaxants (33% and 38%), long-acting strong opioids (25% and 33%) and spinal injections (22% and 43%). Although guidelines recommend staying active, 72% and 67% of ED physicians recommended activity restrictions. CONCLUSION Management of acute non-specific LBP in the ED was not in agreement with current guideline recommendations in a substantial proportion of ED physicians. Overuse of imaging studies, the use of long-acting opioids and muscle relaxants, as well as recommendations for activity and work restrictions were prevalent and may potentially be harmful.
Collapse
Affiliation(s)
- Ilaria Jermini-Gianinazzi
- Emergency Department, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Ticino, Switzerland
| | - Manuel Blum
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria Trachsel
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maurizio Alen Trippolini
- School of Health Professions, Berne University of Applied Sciences, Bern, Switzerland
- Evidence-based Insurance Medicine (EbIM), Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Nicole Tochtermann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Caroline Rimensberger
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Dominik Liechti
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria M Wertli
- Department of General Internal Medicine, Kantonsspital Baden AG, Baden, Aargau, Switzerland
| |
Collapse
|
22
|
Avaghade RR, Shinde SB, Dhane SB. Effectiveness of McKenzie approach and segmental spinal stabilization exercises on neck pain in individuals with cervical postural syndrome: An experimental study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:225. [PMID: 37727425 PMCID: PMC10506789 DOI: 10.4103/jehp.jehp_239_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/07/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND This study "Effectiveness of Mckenzie approach and segmental spinal stabilization exercises on neck pain in individuals with cervical postural syndrome: an experimental study" was conducted to study and find the effectiveness of Mckenzie approach and segmental spinal stabilization exercises on reduction of pain, correction of rounded shoulder, and disability. Pain, disability, and rounded shoulders are the major limiting factors as it affects the quality of life and reduces efficiency and social participation. MATERIALS AND METHODS The study was conducted among 120 individuals with cervical postural syndrome, and fulfilling the inclusion and exclusion criteria was included. The outcome measures were Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Vernier caliper to evaluate pain, functional disability, and rounded shoulder, respectively. Subjects were randomly divided into two groups, Group A and Group B, by using SPSS software. Interventional training was given for 6 weeks to the patients. Group A subjects were given spinal stabilization exercises. Group B subjects were given Mckenzie approach. The statistical analysis was performed using SPSS; pre-test and post-test were used to calculate the results, followed by data presentation and analysis. RESULT The result showed that at the end of the 6 weeks on comparison between pre- and post-intervention of Group A and Group B, both the techniques were effective, but group B was significantly effective than Group A. CONCLUSION It was noted that McKenzie approach and segmental spinal stabilization exercises were effective on neck pain in individuals with cervical postural syndrome, but on comparing both techniques, Mckenzie protocol is more beneficial than segmental spinal stabilization exercises. The study accepts the alternate hypothesis that there is significant effect of McKenzie approach and segmental spinal stabilization exercises on neck pain in individuals with cervical postural syndrome.
Collapse
Affiliation(s)
- Rutuja R. Avaghade
- Department of Physiotherapy, Krishna Institute of Medical Science, Deemed to be University, Karad, Maharashtra, India
| | - Sandeep B. Shinde
- Department of Musculoskeletal Sciences Physiotherapy, Krishna Institute of Medical Science, Deemed to be University, Karad, Maharashtra, India
| | - Sayalee B. Dhane
- Department of Musculoskeletal Sciences Physiotherapy, Krishna Institute of Medical Science, Deemed to be University, Karad, Maharashtra, India
| |
Collapse
|
23
|
Ferrante AN, Keller BK, Flury JS, Harnik MA, grosse Holtforth M, Wertli MM. Effectiveness of Communication Strategies in the Management of Chronic Postsurgical Pain: Protocol for a Systematic Review and Meta-Analysis. J Pain Res 2023; 16:1907-1913. [PMID: 37303695 PMCID: PMC10254707 DOI: 10.2147/jpr.s401685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/13/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose To describe the details of a systematic review to assess the current evidence about the efficacy of communication strategies on the prevention of chronic postsurgical pain (CPSP). Methods The protocol for this systematic review was based on the Cochrane Handbook methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) recommendations. A systematic search of the literature on electronic databases Medline, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science (from the inception to 19 June 2022) was carried out using predefined search terms to identify relevant studies. This review will include randomized clinical trials or observational studies. The search strategy consisted of keywords and index terms related to "clinician", "communication" or "post-surgical pain". Inclusion criteria are as follows: randomized clinical trials or observational studies using a parallel group design that assess the efficacy of communication interventions in patients undergoing surgery and that assess pain and pain-related disability. We considered interventions that included any type of written, verbal, and non-verbal communication in combination with other interventions or without. Control groups may include no communication intervention or another intervention distinctly different. We excluded studies with follow-up duration of less than 3 months, patients aged <18 years, and studies for which no reviewer had language proficiency (eg, Chinese, Korean). Descriptive statistics will be used to summarize quantitative findings. Meta-analysis will only be considered if at least three studies used the same outcome with comparable interventions, as we expect a wide heterogeneity of study population and settings. Conclusion This systematic review and meta-analysis will be an important source for clinicians and researchers to understand the influence of communication to prevent CPSP. Study Registration This protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO). Registration number: CRD42021241596.
Collapse
Affiliation(s)
- Asha-Naima Ferrante
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, University of Bern, Bern, 3010, Switzerland
- Department of Psychology, University of Bern, Bern, 3012, Switzerland
| | - Barbara K Keller
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, University of Bern, Bern, 3010, Switzerland
| | - Julian S Flury
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, University of Bern, Bern, 3010, Switzerland
| | - Michael A Harnik
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin grosse Holtforth
- Department of Psychology, University of Bern, Bern, 3012, Switzerland
- Psychosomatic Competence Center, University Hospital of Bern, Inselspital, University of Bern, Bern, 3010, Switzerland
| | - Maria M Wertli
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, University of Bern, Bern, 3010, Switzerland
- Department of Internal Medicine, Kantonsspital Baden, Baden, 5404, Switzerland
| |
Collapse
|
24
|
Heikkala E, Oura P, Ruokolainen O, Ala-Mursula L, Linton SJ, Karppinen J. The Örebro Musculoskeletal Pain Screening Questionnaire-Short Form and 2-year follow-up of registered work disability. Eur J Public Health 2023:7165278. [PMID: 37192056 DOI: 10.1093/eurpub/ckad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) was developed to identify psychological and functioning-related risk factors among individuals with musculoskeletal pain at risk of work disability. This study aimed to examine whether the short version of the ÖMPSQ (ÖMPSQ-SF) can be used for this purpose, using registry-based outcomes. METHODS The ÖMPSQ-SF was completed by the members of the Northern Finland Birth Cohort 1966 at the age of 46 years (baseline). These data were enriched with national registers, including information on sick leaves and disability pensions (indicators of work disability). The associations between the ÖMPSQ-SF categories (low-, medium- and high risk) and work disability over a 2-year follow-up were analysed using negative binomial regression and binary logistic regression models. We made adjustments for sex, baseline education level, weight status and smoking. RESULTS Overall, 4063 participants provided full data. Of these, 90% belonged to the low-risk, 7% to the medium-risk and 3% to the high-risk group. Compared to the low-risk group, the high-risk group had a 7.5 [Wald 95% confidence interval (CI) 6.2-9.0] times higher number of sick leave days and 16.1 (95% CI 7.1-36.8) times higher odds of disability pension after adjustments in the 2-year follow-up. CONCLUSIONS : Our study suggests that the ÖMPSQ-SF could be used for predicting registry-based work disability at midlife. Those allocated to the high-risk group seemed to have a particularly great need of early interventions to support their work ability.
Collapse
Affiliation(s)
- Eveliina Heikkala
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Wellbeing Services, County of Lapland, Rovaniemi, Finland
| | - Petteri Oura
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Olli Ruokolainen
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Leena Ala-Mursula
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Steven J Linton
- Clinical Psychology, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Finnish Institute of Occupational Health, Oulu, Finland
- Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
| |
Collapse
|
25
|
Ng W, Beales D, Gucciardi DF, Slater H. Applying the behavioural change wheel to guide the implementation of a biopsychosocial approach to musculoskeletal pain care. FRONTIERS IN PAIN RESEARCH 2023; 4:1169178. [PMID: 37228807 PMCID: PMC10204590 DOI: 10.3389/fpain.2023.1169178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Achieving high value, biopsychosocial pain care can be complex, involving multiple stakeholders working synergistically to support the implementation of quality care. In order to empower healthcare professionals to assess, identify and analyse biopsychosocial factors contributing to musculoskeletal pain, and describe what changes are needed in the whole-of-system to navigate this complexity, we aimed to: (1) map established barriers and enablers influencing healthcare professionals' adoption of a biopsychosocial approach to musculoskeletal pain against behaviour change frameworks; and (2) identify behaviour change techniques to facilitate and support the adoption and improve pain education. A five-step process informed by the Behaviour Change Wheel (BCW) was undertaken: (i) from a recently published qualitative evidence synthesis, barriers and enablers were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF) using "best fit" framework synthesis; (ii) relevant stakeholder groups involved in the whole-of-health were identified as audiences for potential interventions; (iii) possible intervention functions were considered based on the Affordability, Practicability, Effectiveness and Cost-effectiveness, Acceptability, Side-effects/safety, Equity criteria; (iv) a conceptual model was synthesised to understand the behavioural determinants underpinning biopsychosocial pain care; (v) behaviour change techniques (BCTs) to improve adoption were identified. Barriers and enablers mapped onto 5/6 components of the COM-B model and 12/15 domains on the TDF. Multi-stakeholder groups including healthcare professionals, educators, workplace managers, guideline developers and policymakers were identified as target audiences for behavioural interventions, specifically education, training, environmental restructuring, modelling and enablement. A framework was derived with six BCTs identified from the Behaviour Change Technique Taxonomy (version 1). Adoption of a biopsychosocial approach to musculoskeletal pain involves a complex set of behavioural determinants, relevant across multiple audiences, reflecting the importance of a whole-of-system approach to musculoskeletal health. We proposed a worked example on how to operationalise the framework and apply the BCTs. Evidence-informed strategies are recommended to empower healthcare professionals to assess, identify and analyse biopsychosocial factors, as well as targeted interventions relevant to various stakeholders. These strategies can help to strengthen a whole-of-system adoption of a biopsychosocial approach to pain care.
Collapse
Affiliation(s)
- Wendy Ng
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Darren Beales
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Curtin University, Perth, WA, Australia
| | - Daniel F. Gucciardi
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Curtin University, Perth, WA, Australia
| | - Helen Slater
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Curtin University, Perth, WA, Australia
| |
Collapse
|
26
|
Bates NA, Huffman A, Goodyear E, Nagai T, Rigamonti L, Breuer L, Holmes BD, Schilaty ND. Physical clinical care and artificial-intelligence-guided core resistance training improve endurance and patient-reported outcomes in subjects with lower back pain. Clin Biomech (Bristol, Avon) 2023; 103:105902. [PMID: 36805199 DOI: 10.1016/j.clinbiomech.2023.105902] [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: 07/28/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Low back pain is an extremely prevalent issue with an extensive impact, ranging from decreased quality of life to lost years of productivity. Many interventions have been developed to alleviate chronic lower back pain, yet it remains a widespread problem. The objective of this study was to examine the role of artificial intelligence guided resistance training relative to clinical variables in subjects experiencing lower back pain. METHODS 69 out of 108 enrolled and 92 accrued subjects completed the 8-week intervention. Subjects were randomized into four groups (Control, Training, Clinical, or Combined). The Training cohort received supervised artificial-intelligence-guided core-focused resistance training while the Clinical group received clinical care. The Combined group received both clinical care and artificial-intelligence-guided training and the Control group received no treatment. Participants were evaluated using functional testing and patient-reported outcomes at baseline, 4 weeks, and 8 weeks. FINDINGS In the clinical tests, the Clinical and Combined cohorts showed increased total time for isometric extensor endurance and the Clinical cohort increased total distance traveled in the 6-min walk test at 8 weeks. The Training, Clinical, and Combined groups showed improvements in Patient-reported outcomes after 8 weeks. Most of the significant improvements were only seen at the 8-week evaluation for both the clinical evaluations and Patient-reported outcomes. The Control group did not show significant improvements in any outcome measures. INTERPRETATION The present data indicate that core-focused interventions, including artificial-intelligence-guided moderate-resistance exercise, can increase objective functional outcomes and patient satisfaction using Patient-reported outcomes in individuals with lower back pain.
Collapse
Affiliation(s)
- Nathaniel A Bates
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Allison Huffman
- The Ohio State University School of Medicine, Columbus, OH, USA
| | - Evelyn Goodyear
- The Ohio State University School of Medicine, Columbus, OH, USA
| | - Takashi Nagai
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; United States Army Research Institute of Environmental Medicine, Natick, MA, United States of America
| | - Luca Rigamonti
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Logan Breuer
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Nathan D Schilaty
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, FL, USA; Center for Neuromusculoskeletal Research, University of South Florida, Tampa, FL, USA
| |
Collapse
|
27
|
The prognostic value of fear-avoidance beliefs on postoperative pain and dysfunction for lumbar degenerative disk disease: a meta-analysis. Int J Rehabil Res 2023; 46:3-13. [PMID: 36652201 DOI: 10.1097/mrr.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The study aimed to explore the prognostic value of fear-avoidance beliefs (FABs) on postoperative pain and back-specific function for patients with lumbar degenerative disk disease (LDDD). FABs have been proven to be a predictorof pain and disability for patients with low back pain. However, whether FABs are a predictor of surgical outcomes for LDDD is a matter of debate. PubMed, Cochrane library, EMBASE, and EBSCO were searched for eligible cohort studies or secondary analyses of randomized controlled trials. Fixed-effect meta-analysis models were used to estimate odds ratios (OR) because of absent or low heterogeneity ( I ² < 50%). Subgroup analyses were conducted according to different follow-up durations. Forest plots were used for graphical representation. Six studies with a total of 829 participants were included in the meta-analyses. Risk of bias was high for three studies and moderate for the other three studies. For patients with LDDD, meta-analyses showed that FABs were a predictor of postoperative pain intensity [OR 2.88; 95% confidence interval (CI), 2.76-3.00] and back-specific function (OR 3.13; 95% CI, 3.02-3.24). Patients with FABs are less likely to report improvement in pain (OR 2.56; 95% CI, 1.73-3.86) and function (OR 2.81; 95% CI, 2.57-3.07). In conclusion, FABs were a predictor of postoperative pain and back-specific function for patients with LDDD. This prognostic value is sustained for a long period after surgery (>12 months). Clinicians are advised to initiate targeted interventions for patients with FABs at different stages after surgery. Due to the limited number and low quality of included studies, the results of this meta-analysis should be interpreted with caution.
Collapse
|
28
|
Picariello F, Chilcot J, Chalder T, Herdman D, Moss-Morris R. The Cognitive and Behavioural Responses to Symptoms Questionnaire (CBRQ): Development, reliability and validity across several long-term conditions. Br J Health Psychol 2023; 28:619-638. [PMID: 36690909 DOI: 10.1111/bjhp.12644] [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: 09/21/2022] [Revised: 12/07/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Cognitive and behavioural responses to symptoms can worsen or maintain the severity of symptoms across long-term conditions (LTCs). Although the Cognitive and Behavioural Responses Questionnaire (CBRQ) has been used in research, its original development and psychometric properties as a transdiagnostic measure have not been reported. Our aim was to evaluate the psychometric properties of the CBRQ and a recently proposed short version, across different LTCs. DESIGN Psychometric validation study. METHODS Confirmatory factor analysis (CFA) tested the factor structure of the CBRQ in two datasets from the CBRQ's original development; (chronic fatigue syndrome, N = 230; and multiple sclerosis, N = 221) and in additional groups: haemodialysis (N = 174), inflammatory bowel disease (N = 182) and chronic dizziness (N = 185). Scale reliability and construct validity were assessed. The factor structure of the shortened CBRQ (CBRQ-SF) was also assessed. RESULTS CFA revealed that a 7-or 8-factor structure had generally appropriate fit supporting the originally proposed 7 factors (Fear avoidance, Damage beliefs, Catastrophising, Embarrassment avoidance, Symptom focusing, All-or-nothing behaviour and Avoidance/Resting behaviour). Omega coefficients indicated satisfactory internal reliability. Correlations with related constructs suggested construct validity. The scale appeared sensitive to change. The CBRQ-SF also displayed good psychometric quality, with a better model fit than the CBRQ. CONCLUSIONS The CBRQ and the shortened version were shown to be reliable and valid at assessing a range of cognitive and behavioural responses to symptoms, highlighting the multi-symptom, transdiagnostic properties of this questionnaire. Further research is necessary to determine the test-retest reliability and sensitivity to change of the CBRQ and CBRQ-SF and a thorough evaluation of the content validity of the items.
Collapse
Affiliation(s)
- Federica Picariello
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Trudie Chalder
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - David Herdman
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| |
Collapse
|
29
|
Sadeghi-Yarandi M, Ghasemi M, Ghanjal A, Sepandi M, Soltanzadeh A. The Prediction of Chronicity in Patients With Acute and Subacute Nonspecific Low Back Pain and Associated Risk Factors: A Case-Control Study. Pain Manag Nurs 2022; 23:838-847. [PMID: 35177310 DOI: 10.1016/j.pmn.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/03/2022] [Accepted: 01/16/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic low back pain is one of the most common musculoskeletal disorders in different countries. AIMS This study aimed to predict the chronicity of nonspecific acute and nonspecific low back pain (LBP) and related risk factors among cases referred to physiotherapy clinics. DESIGN A case-control and cross-sectional study. SETTINGS Two physiotherapy centers in Tehran, Iran. PARTICIPANTS This study included 502 patients with acute, subacute and chronic LBP. METHOD This study included 502 patients with acute, subacute and chronic LBP. Data were obtained using the Fear-Avoidance Beliefs Questionnaire, Patient Health Questionnaire, Pain Catastrophic Scale, Tampa Scale for Kinesiophobia, Pittsburgh Sleep Quality Index, Walker's Health-Promoting Lifestyle Questionnaire, Roland Morris Disability Questionnaire, and Numerical Pain Rating Scale. Data analysis was performed by applying independent sample t test, χ2, and multiple logistic regression in SPSS software version 25. IBM Amos version 22 was used for path analysis. RESULTS It was found that some demographic parameters (i.e., weight, BMI, job, type of occupational task performance, history of low back pain, work shift, underlying diseases and income), some cognitive parameters (i.e., fear-avoidance beliefs, kinesiophobia, catastrophic pain, and depression), some lifestyle parameters (i.e., health responsibility, physical activity, and interpersonal relationships), sleep quality and pain related disability were among the most critical risk factors in the chronicity of acute and subacute LBP (p < .05). CONCLUSIONS Personal, psychological, and psychosocial parameters can be among the most critical predictors in the chronicity of acute and subacute nonspecific LBP. Hence, paying attention to all the mentioned factors at the beginning of patients' treatment to create a targeted treatment algorithm and prevent the conversion of acute and subacute into chronic LBP has particular importance.
Collapse
Affiliation(s)
- Mohsen Sadeghi-Yarandi
- Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghasemi
- Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Ali Ghanjal
- Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mojtaba Sepandi
- Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ahmad Soltanzadeh
- Department of Occupational Safety and Health Engineering, Health Faculty, Qom University of Medical Sciences, Qom, Iran
| |
Collapse
|
30
|
Harris S, Roddey T, Shelton T, Bailey L, Brewer W, Ellison J, Wang W, Gleeson P. The functional lumbar index: Validation of a novel clinical assessment tool for individuals with low back pain. Musculoskelet Sci Pract 2022; 62:102666. [PMID: 36179496 DOI: 10.1016/j.msksp.2022.102666] [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: 05/16/2021] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Retrospective Diagnostic Cohort Study. LEVEL OF EVIDENCE Level 3b. OBJECTIVES To examine the concurrent and predictive validity of a novel clinical assessment tool, the Functional Lumbar Index (FLI). BACKGROUND Lumbar surgeries have increased exponentially in the past decade, adding to healthcare costs without improving outcomes. Limitations in clinicians' abilities to identify those individuals who are most likely to benefit from surgery may be enhanced with an effective physical assessment tool. METHODS The FLI was assessed on 291 individuals (179 conservative and 113 pre-surgical) seeking care for low-back pain (LBP) over a 2.5-year period. The FLI consists of several physical performance tests (PPT) with a novel criterion-based scoring system. Pearson correlations and Poisson regression analysis were used to establish concurrent and predictive validity at alpha = 0.05. RESULTS The subscale FLI components showed good to excellent inter-rater reliability with intraclass correlation coefficient values as follows: front plank = .993, right side plank = .824, left side plank .861, Sorensen = 0.836, overhead squat = 0.937. A statistically significant, moderate negative correlation was observed between FLI and modified Oswestry Disability Index (r = -0.540, p < .001). Regression analysis showed the FLI as the only significant predictor (p = .004) of failed conservative management for individuals with LBP. An ROC curve showed significant group prediction of the FLI with an AUC of 0.788 (p < .001) and cut-off score of 7.5. CONCLUSION The FLI is a reliable and valid measure for predicting failed conservative care management in patients with LBP. Clinicians are encouraged to use the FLI as part of their physical assessment when screening individuals with LBP who might need surgical intervention. Further research is needed to determine validity of the FLI in other patient populations. PUBLIC TRIAL REGISTRY N/A.
Collapse
Affiliation(s)
- Sean Harris
- Texas Woman's University, Houston, TX, USA; Memorial Hermann Health System, Houston, TX, USA.
| | | | | | - Lane Bailey
- Memorial Hermann Health System, Houston, TX, USA
| | | | | | - Wanyi Wang
- Texas Woman's University, Houston, TX, USA
| | | |
Collapse
|
31
|
Alamam D, Alhowimel A, Alodaibi F, Alsobayel H. Are healthcare providers offering the proper education for people with low back pain? Content analysis of educational materials. J Back Musculoskelet Rehabil 2022; 35:1269-1276. [PMID: 35599466 DOI: 10.3233/bmr-210232] [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: 02/04/2023]
Abstract
BACKGROUND Low back pain (LBP) is a prevalent disorder and leading cause of disability worldwide. In Saudi Arabia, patients with LBP are dispensed with educational materials to supposedly facilitate their recuperation. OBJECTIVE Appraise the suitability of educational materials provided for people with LBP in Saudi Arabia to determine whether they meet the needs of patients, inform self-management, and are consistent with clinical practice guidelines. METHODS A qualitative data collection method was used, and content analyses were conducted to analyse data based on manifest content. Educational items in English and Arabic were collected from relevant health providers in Saudi Arabia. RESULTS Seventeen educational materials were sourced from: Ministry of Health hospitals (n= 10), military hospitals (n= 4), private hospitals (n= 2), and a multidisciplinary healthcare association (n= 1). Six identified sub-themes comprise: epidemiological/anatomical data about LBP (n= 6); causes/risk factors (n= 10); exercise (n= 14) and physical activity-related (n= 3) recommendations; treatment-related recommendations (n= 2); general health and lifestyle-related recommendations (n= 8); and postural and ergonomics-related recommendations (n= 13). A common theme emerged, that 'the content of educational materials hindered reassurance and self-management for people with LBP.' CONCLUSION The reviewed educational materials fail to adequately report information that assure patients or inform their self-management among the Saudi population with LBP. Further, reviewed items are heavily influenced by the biomedical model of pain.
Collapse
Affiliation(s)
- Dalyah Alamam
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Alhowimel
- Department of Health and Rehabilitation Science, Prince Sattam bin Abdulaziz University, Alkarj, Kingdom of Saudi Arabia
| | - Faris Alodaibi
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hana Alsobayel
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Research Chair for Health Care Innovation, King Saud University, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
32
|
Ho-A-Tham N, Struyf N, Ting-A-Kee B, de Almeida Mello J, Vanlandewijck Y, Dankaerts W. Physical activity, fear avoidance beliefs and level of disability in a multi-ethnic female population with chronic low back pain in Suriname: A population-based study. PLoS One 2022; 17:e0276974. [PMID: 36315484 PMCID: PMC9621425 DOI: 10.1371/journal.pone.0276974] [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: 12/08/2021] [Accepted: 10/18/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) is an important cause for reduced daily physical activity (PA) and loss of quality of life, especially in women. In Suriname, a middle-income country in South America, the relationship between PA and CLBP is still unknown. AIMS To assess the level of PA in women with CLBP of different ethnicity, and to identify whether fear avoidance beliefs (FAB), disability, co-occurring musculoskeletal pain sites and various sociodemographic and lifestyle factors were associated with self-reported PA. METHODS A cross-sectional community-based house-to-house survey was conducted between April 2016 and July 2017. The survey followed the Community Oriented Program for Control of Rheumatic Diseases methodology. Selection criteria were being female of Asian-Surinamese, African-Surinamese or of Mixed ethnicity and aged 18 or older, living in an urban area, and reporting CLBP. Data was collected on PA, FAB, disability, co-occurring musculoskeletal pain sites, CLBP intensity and sociodemographic and lifestyle factors. RESULTS Urban adult women with current CLBP (N = 210) were selected. Nearly 57% of the population met the WHO recommendation on PA, with work-related PA as the largest contributor to total self-reported PA. Most women showed low FAB scores (FABQ-Work ≤34 (96.2%) and FABQ-PA ≤14 (57.6%)) and low disability levels (Oswestry Disability Index ≤20 (62.4%)). An inverse association between total PA and FABQ-Work (OR = 0.132, CI: 0.023; 0.750) was found. In contrast, total PA had a significant, positive association with disability (OR = 2.154, CI: 1.044; 4.447) and workload (OR = 2.224, CI: 1.561; 3.167). All other variables showed no association with total PA. CONCLUSION This was the first study in Suriname reporting that 43.3% of urban adult women with CLBP were physically inactive. Total self-reported PA is influenced by FABQ-Work, average to heavy workload and moderate to severe disability. In this study, PA-Work was the major contributor to total PA. Therefore, future longitudinal studies should evaluate different types and aspects of PA in relation to CLBP management.
Collapse
Affiliation(s)
- Nancy Ho-A-Tham
- Department of Physiotherapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- * E-mail: ,
| | - Niels Struyf
- Department of Physiotherapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Beverly Ting-A-Kee
- Department of Pathology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | | | - Yves Vanlandewijck
- Department of Rehabilitation Sciences, Research Group of Adapted Physical Activity and Psychomotor Rehabilitation, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Physiology, Nutrition and Biomechanics, Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
33
|
Liew BXW, Syrett J, Freeman P, Evans DW. Pain-related fear of movement dynamics in individuals with and without low back pain participating in weightlifting and/or powerlifting training. PLoS One 2022; 17:e0276983. [PMID: 36302048 PMCID: PMC9612576 DOI: 10.1371/journal.pone.0276983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Pain-free adults in the general population have been shown to possess unhelpful beliefs that certain movements and postures are harmful to the spine, potentially reinforcing fear-avoidance behaviour. Whether such beliefs occur in individuals undertaking regular powerlifting (PL) and Olympic weightlifting (OWL) training is unclear. METHODS In a cross-sectional study design, 67 individuals who participate in OWL and PL training completed an online survey. Demographic characteristics, training history, and self-reported perceptions of harm, on the 40-item Photograph Series of Daily Activities shortened electronic version (PHODA-SeV), were collected. After removing collinear variables, 13 items were entered into a network analysis, in which the adjusted correlations between items, and the centrality indices of each item (i.e., the degree of connection with other symptoms in the network) were quantified. RESULTS Twenty-one (31.3%) participants had LBP symptoms. The pairwise correlations with the greatest magnitudes were between images of 'leg stretch' and 'jumping' (0.32 [95%CI 0.08 to 0.45]) and two images depicting ironing (0.32 [95%CI 0.05 to 0.54]) respectively. The three most Central (connected) items were 'stair ascend', 'walking with groceries', and 'mopping with spine flexion'. CONCLUSIONS For individuals training in OWL and PL, images reflecting walking, rather than those depicting high spinal flexion angle, had greater connectivity to other activity items. In addition, the strongest correlations were not between items reflecting high spinal flexion angle. Future studies that investigate the relationship between different intensities of OWL and PL training and the dynamics of pain-related fear are warranted.
Collapse
Affiliation(s)
- Bernard X. W. Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
- * E-mail: ,
| | - Josce Syrett
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - Paul Freeman
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - David W. Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| |
Collapse
|
34
|
Cooper C, Frey B, Day C. Development and validation of a military fear avoidance questionnaire. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:979776. [PMID: 36262915 PMCID: PMC9574069 DOI: 10.3389/fresc.2022.979776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/16/2022] [Indexed: 11/07/2022]
Abstract
Chronic pain due to musculoskeletal injury is one of the leading causes of disability and reduced combat readiness in the U.S. Army. Unidimensional pain management systems are not effective in addressing the complex phenomenon of pain-related disability. Growing evidence has supported use of the Fear Avoidance Model (FAM) as a suitable model to address pain-related disability and chronicity from a multidimensional pain neuroscience approach. While several fear avoidance measurement tools exist, one that addresses the complexity of the Army environment encouraged the authors to develop and test the reliability and validity of a military specific questionnaire. This study developed and validated an Army specific fear avoidance screening, the Return to Duty Readiness Questionnaire (RDRQ), which subsequently demonstrated good psychometric properties. Reliability coefficients demonstrate high internal consistency values both during pilot study (α = 0.96) and validation study (α = 0.94, ωt = 0.94). A Correlation Coefficient of 0.74 when compared with the Fear Avoidance Components Scale (FACS) suggests good concurrent validity. Future study should include replication in a new army population, investigation of responsiveness, test-retest reliability, structural validity and establishing severity scores with minimal clinically important differences to enhance utility.
Collapse
Affiliation(s)
- Carly Cooper
- Brooke Army Medical Center, Department of Occupational Therapy, US Army, Fort Sam Houston, TX, United States,Correspondence: Carly Cooper
| | - Bruce Frey
- Department of Educational Psychology and Research, University of Kansas, Lawrence, KS, United States
| | - Charles Day
- Irwin Army Community Hospital, Soldier Centered Medical Homes, US Army, Fort Riley, KS, United States
| |
Collapse
|
35
|
Duport A, Pelletier R, Martel M, Léonard G. The influence of kinesiophobia and pain catastrophizing on pain-induced corticomotor modulation in healthy participants: A cross sectional study. Neurophysiol Clin 2022; 52:375-383. [DOI: 10.1016/j.neucli.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/06/2022] Open
|
36
|
Inman JGK, Ellard DR. What influences graduate medical students' beliefs of lower back pain? A mixed methods cross sectional study. BMC MEDICAL EDUCATION 2022; 22:633. [PMID: 35987611 PMCID: PMC9392230 DOI: 10.1186/s12909-022-03692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Low back pain (LBP) is a common condition with substantial associated disability and costs, best understood using a biopsychosocial approach. Research demonstrates that beliefs about LBP are important, with biomedical beliefs influencing practitioner's management and patient recovery. Beliefs about LBP can be inconsistent amongst healthcare and medical students. The aim of this study was to investigate graduate medical student's beliefs of LBP and what influences them. METHOD A cross sectional mixed methods study of Phase 1 (first year) and Phase 3 (third and fourth year) current graduate medical students at the University of Warwick (MBChB) was conducted. Participants were recruited via voluntary response sampling. A survey investigated LBP beliefs, utilising the Back Beliefs Questionnaire (BBQ) and Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS). Qualitative data was collected on what influences beliefs about the causes and management of LBP, which was analysed descriptively using thematic analysis. RESULTS Fifty-seven students completed the questionnaire (61% female), with a mean age of 27.2 years. Eighty two percent of participants reported a history of LBP. Median BBQ scores were 31.5 for phase 1 and 31 for phase 3, with median HC-PAIRS scores of 57 and 60 for phase 1 and phase 3 students respectively. Three main themes emerged from the qualitative data: Sources of influence, influence of personal experience and influence of medical education. Participants discussed single or multiple sources influencing their beliefs about the causes and management of LBP. Another main theme was the influence of experiencing LBP personally or through discussions with family, friends and patients. The final main theme described the influence of medical education, including lectures, seminars and clinical placements. CONCLUSIONS The HC-PAIRS and BBQ scores suggest graduate medical students in this sample tended to have positive beliefs about the outcome of LBP and functional expectations of chronic LBP patients, consistent with other healthcare students. The findings from qualitative data suggest how medical students form beliefs about the causes and management of LBP is complex.
Collapse
Affiliation(s)
- John G. K. Inman
- Warwick Medical School, Medical School Building, University of Warwick, Coventry, CV4 7HL UK
| | - David R. Ellard
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7HL UK
| |
Collapse
|
37
|
Ayre J, Jenkins H, McCaffery KJ, Maher CG, Hancock MJ. Unique considerations for exercise programs to prevent future low back pain: the patient perspective. Pain 2022; 163:e953-e962. [PMID: 34799535 DOI: 10.1097/j.pain.0000000000002540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is moderate quality evidence that exercise can help to prevent future low back pain (LBP). This study aimed to explore patient needs and preferences for exercise programs to prevent LBP and the outcomes of these programs that would be most important to a patient. Researchers conducted 26 semistructured interviews with people with LBP. Interviews were audio-recorded, transcribed, and analysed using framework thematic analysis. Three themes were developed. Theme 1 emphasised that everyone's LBP was different, translating to preferences for tailored prevention programs with a high level of initial supervision and individualised biomedical explanations for the program. Theme 2 highlighted important outcomes. Pain was considered not only for intensity but also for the duration, frequency, and severity of flare-ups or episodes. Other important outcomes were general fitness and capacity to engage in everyday activities, social interactions, and work. Theme 3 outlined aspects of exercise programs that were considered important for people with fluctuating pain, including how to foster a sense of "progress," set realistic expectations, and support patients to establish exercise routines that can adapt to fluctuating pain. Theme 4 discussed participants' desire for social connection. Patients want exercise programs for LBP prevention, which are highly individualised, provide meaningful explanations of exercises, and help them maintain exercise in the long-term. Clinicians should discuss with patients the transition from a focus on treatment to the prevention of LBP. This provides greater opportunity to adjust goals and expectations and provide relevant education. Balancing the need for individualised care against affordability presents an ongoing challenge.
Collapse
Affiliation(s)
- Julie Ayre
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Hazel Jenkins
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Kirsten J McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Mark J Hancock
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| |
Collapse
|
38
|
Wang H, Hu F, Lyu X, Jia H, Wang B, Liu F, Yang Y. Kinesiophobia could affect shoulder function after repair of rotator cuff tears. BMC Musculoskelet Disord 2022; 23:714. [PMID: 35883122 PMCID: PMC9316366 DOI: 10.1186/s12891-022-05679-x] [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: 02/03/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Kinesiophobia (fear of movement) is a major limiting factor in the return to pre-injury sport level after surgery of rotator cuff tears. The study aims to gain insights into how kinesiophobia affects shoulder pain and function after the repair of full-thickness rotator cuff tears. Methods A prospective study was conducted to evaluate patients who underwent rotator cuff repair between January 2019 and December 2019 in our institution. The patients were divided into a trial group with a high kinesiophobia (Tampa Scale for Kinesiophobia [TSK], TSK > 37) and a control group with a low kinesiophobia (TSK ≤ 37). The indicators of interest included the Constant-Murley scores, numerical rating scale (NRS), visual analogue scale (VAS), Oxford Shoulder Score (OSS), and the American shoulder and elbow score (ASES), shoulder function and strength, and range of motion (ROM) at 3 days, 6 weeks, and 12 months after repair of full-thickness rotator cuff tears. Results In total, 49 patients who underwent repair of full-thickness rotator cuff tears were enrolled, which was divided into a trial group involving 26 patients (mean TSK 52.54) and a control group involving 23 patients (mean TSK 33.43). There were no statistically significant differences in basic information such as age, gender, and length of stay in the two groups. The preoperative and early postoperative functional scores and the Tampa Scale for Kinesiophobia were statistically significant differences between the two groups. However, long-term postoperative follow-up showed no statistically significant difference in ASES, and Constant-Murley scores, OSS, and VAS scores between the two groups as the kinesiophobia changed from positive to negative. Conclusion Degree of kinesiophobia reduced during post-operative rehabilitation of rotator cuff repair patients, but high kinesiophobia is still present in a large portion of the patients after rotator cuff repair. Patients after rotator cuff repair will benefit from early recognition and prevention of kinesiophobia.
Collapse
Affiliation(s)
- Huihui Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fangning Hu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Xiaolong Lyu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Honglei Jia
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Yongliang Yang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
| |
Collapse
|
39
|
McParlin Z, Cerritelli F, Rossettini G, Friston KJ, Esteves JE. Therapeutic Alliance as Active Inference: The Role of Therapeutic Touch and Biobehavioural Synchrony in Musculoskeletal Care. Front Behav Neurosci 2022; 16:897247. [PMID: 35846789 PMCID: PMC9280207 DOI: 10.3389/fnbeh.2022.897247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/24/2022] [Indexed: 12/05/2022] Open
Abstract
Touch is recognised as crucial for survival, fostering cooperative communication, accelerating recovery, reducing hospital stays, and promoting overall wellness and the therapeutic alliance. In this hypothesis and theory paper, we present an entwined model that combines touch for alignment and active inference to explain how the brain develops "priors" necessary for the health care provider to engage with the patient effectively. We appeal to active inference to explain the empirically integrative neurophysiological and behavioural mechanisms that underwrite synchronous relationships through touch. Specifically, we offer a formal framework for understanding - and explaining - the role of therapeutic touch and hands-on care in developing a therapeutic alliance and synchrony between health care providers and their patients in musculoskeletal care. We first review the crucial importance of therapeutic touch and its clinical role in facilitating the formation of a solid therapeutic alliance and in regulating allostasis. We then consider how touch is used clinically - to promote cooperative communication, demonstrate empathy, overcome uncertainty, and infer the mental states of others - through the lens of active inference. We conclude that touch plays a crucial role in achieving successful clinical outcomes and adapting previous priors to create intertwined beliefs. The ensuing framework may help healthcare providers in the field of musculoskeletal care to use hands-on care to strengthen the therapeutic alliance, minimise prediction errors (a.k.a., free energy), and thereby promote recovery from physical and psychological impairments.
Collapse
Affiliation(s)
- Zoe McParlin
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | - Francesco Cerritelli
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | | | - Karl J. Friston
- Institute of Neurology, Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Jorge E. Esteves
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Malta ICOM Educational, Gzira, Malta
- University College of Osteopathy, London, United Kingdom
| |
Collapse
|
40
|
Alves Rodrigues T, de Oliveira EJSG, Morais Costa B, Tajra Mualem Araújo RL, Batista Santos Garcia J. Is There a Difference in Fear-Avoidance, Beliefs, Anxiety and Depression Between Post-Surgery and Non-Surgical Persistent Spinal Pain Syndrome Patients? J Pain Res 2022; 15:1707-1717. [PMID: 35734508 PMCID: PMC9208625 DOI: 10.2147/jpr.s348146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients with post-surgery persistent spinal pain syndrome (PSPS) or non-surgical PSPS might be affected by sustained fear-avoidance beliefs (FAB), anxiety and depression. In this scenario, this study aimed to describe those aspects in patients with post-surgery PSPS and non-surgical PSPS. Methods This study included patients with PSPS, and non-surgical PSPS, over 18 years, with quarterly evaluations at the Chronic Pain Clinic. After evaluation, demographic and clinical characteristics were obtained. The Beck Depression Inventory-II, Beck Anxiety Inventory, Douleur neuropathique 4 questions, Visual Analog Pain Scale, and Fear-Avoidance Beliefs Questionnaire-Brazilian Version (FABQ-Brazil) were used to evaluate psychological aspects. Results Forty-six patients were included, 23 patients with post-surgery PSPS and 23 with non-surgical PSPS. Both groups had high scores in the physical and work domains of the FABQ, high rates of absenteeism and most patients in these groups had moderate-to-severe neuropathic pain and some degree of anxiety and/or depression. The groups showed no statistically significant difference (p > 0.05) when comparing all questionnaires. Discussion This is one of the first studies to evaluate FAB and other associated psychological factors, such as anxiety and depression, in patients with post-surgery PSPS in a follow-up several years after surgery and compare with patients diagnosed with non-surgical PSPS. In this study, most patients in both groups had high scores in the FABQ domains, not having statistically relevant difference between groups. Conclusion Even though there was no statistically relevant difference between the PSPS patient with or without surgical history in terms of the assessed outcome measures, the described scores for fear-avoidance beliefs, pain, anxiety and depression were high, showing an interference in the daily life activities of those patients.
Collapse
Affiliation(s)
- Thiago Alves Rodrigues
- Chronic Pain Clinic, University Hospital of the Federal University of Maranhão (HU-UFMA), São Luís, Maranhão, Brazil
| | | | - Beatriz Morais Costa
- Chronic Pain Clinic, University Hospital of the Federal University of Maranhão (HU-UFMA), São Luís, Maranhão, Brazil
| | | | - João Batista Santos Garcia
- Chronic Pain Clinic, University Hospital of the Federal University of Maranhão (HU-UFMA), São Luís, Maranhão, Brazil
| |
Collapse
|
41
|
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]
|
42
|
Murillo C, Vo TT, Vansteelandt S, Harrison LE, Cagnie B, Coppieters I, Chys M, Timmers I, Meeus M. How do psychologically based interventions for chronic musculoskeletal pain work? A systematic review and meta-analysis of specific moderators and mediators of treatment. Clin Psychol Rev 2022; 94:102160. [PMID: 35561510 PMCID: PMC11146991 DOI: 10.1016/j.cpr.2022.102160] [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: 06/10/2021] [Revised: 03/18/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
Abstract
Psychologically based interventions aim to improve pain-related functioning by targeting pain-related fears, cognitions and behaviors. Mediation and moderation analyses permit further examination of the effect of treatment on an outcome. This systematic review and meta-analysis aims to synthetize the evidence of specific mediators and moderators (i.e., treatment targets) of psychologically based treatment effects on pain and disability. A total of 28 mediation and 11 moderation analyses were included. Thirteen mediation studies were included in a meta-analysis, and the rest was narratively synthetized. Reductions in pain-related fear (indirect effect [IE]: -0.07; 95% confidence interval [CI]: -0.11, -0.04) and catastrophizing (IE: -0.07; 95%CI: -0.14, -0.00), as well as increases in self-efficacy (IE: -0.07; 95%CI: -0.11, -0.04), mediated effects of cognitive behavioral therapy on disability but not on pain intensity, when compared to control treatments. Enhancing pain acceptance (IE: -0.17; 95%CI: -0.31, -0.03) and psychological flexibility (IE: -0.30; 95%CI: -0.41, -0.18) mediated acceptance and commitment therapy effects on disability. The narrative synthesis showed conflicting evidence, which did not support a robust moderated effect for any of the examined constructs. Overall, the methodological quality regarding mediation was low, and some key pitfalls are highlighted alongside recommendations to provide a platform for future research.
Collapse
Affiliation(s)
- Carlos Murillo
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium
| | - Tat-Thang Vo
- Department of Statistics, The Wharton School, University of Pennsylvania, Pennsylvania, United States; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, California, United States
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Iris Coppieters
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Marjolein Chys
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Inge Timmers
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, California, United States; Department of Rehabilitation Medicine, Maastricht University, Netherlands
| | - Mira Meeus
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium; MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences and Medicine, University of Antwerp, Belgium.
| |
Collapse
|
43
|
Gevers-Montoro C, Deldar Z, Furlan A, Lazar EA, Ghalibaf E, Ortega-De Mues A, Khatibi A. From hands-on to remote: Moderators of response to a novel self-management telehealth programme during the COVID-19 pandemic. Eur J Pain 2022; 26:1368-1379. [PMID: 35610958 PMCID: PMC9320893 DOI: 10.1002/ejp.1968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/17/2022] [Accepted: 05/04/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND In March 2020, state-wide lockdowns were declared in many countries, including Spain. Citizens were confined to their homes and remotely supported activities were prioritized as an alternative to in-person interactions. Previous data suggest that remote and self-management interventions may be successful at reducing pain and related psychological variables. However, individual factors influencing the effectiveness of these interventions remain to be identified. We aimed to investigate the psychological and motivational factors moderating changes in pain observed in chiropractic patients undertaking a novel telehealth self-management programme. METHODS A cohort of 208 patients from a chiropractic teaching clinic was recruited to participate in the study. Patients received telehealth consultations and individualized self-management strategies tailored for their current complaint. They were encouraged to make use of these strategies daily for 2-4 weeks, whilst rating their pain intensity, motivation and adherence. Validated questionnaires were completed online to assess catastrophizing, kinesiophobia and anxiety. RESULTS A total of 168 patients completed the first 2 weeks of the programme, experiencing significant reductions in all variables. Kinesiophobia emerged as a key factor influencing pain reduction and moderating the association between motivation and pain relief. In turn, adherence to the programme was associated with lower pain intensity, although moderated by the degree of motivation. CONCLUSIONS In the context of COVID-19, when introducing remote and self-management strategies, pain cognitions and motivational factors should be taken into consideration to foster adherence and yield better pain outcomes.
Collapse
Affiliation(s)
- Carlos Gevers-Montoro
- Madrid College of Chiropractic - RCU María Cristina, Madrid, Spain.,Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Zoha Deldar
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Andrea Furlan
- KITE, Toronto Rehabilitation Institute, University of Toronto, University Health Network, Institute for Work & Health, Toronto, Ontario, Canada
| | - Eric A Lazar
- Madrid College of Chiropractic - RCU María Cristina, Madrid, Spain
| | - Erfan Ghalibaf
- Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | | | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK.,Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| |
Collapse
|
44
|
Miki T, Kondo Y, Kurakata H, Buzasi E, Takebayashi T, Takasaki H. The effect of cognitive functional therapy for chronic nonspecific low back pain: a systematic review and meta-analysis. Biopsychosoc Med 2022; 16:12. [PMID: 35597961 PMCID: PMC9123771 DOI: 10.1186/s13030-022-00241-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background To apply the Bio-Psych-Social (BPS) model into clinical practice, it is important not to focus on psychosocial domains only since biomedical factors can also contribute to chronic pain conditions. The cognitive functional therapy (CFT) is the management system based on the BPS model for chronic nonspecific low back pain (CNSLBP). Objectives This study aimed to compare CFT with the other interventions for CNSLBP regarding pain, disability/functional status, QoL and psychological factors. Design This study was a systematic review and meta-analysis of a randomised controlled trial. Method Literature Search was conducted in electronic search engines. Enrolled participants included 1) CNSLBP and 2) primary, secondary, or tertiary care patients. CFT was the interventions included. Comparisons were any types of treatment. Results Three studies met the eligibility criteria. The total number of participants was 336. For pain intensity, MD [95% CIs] was -1.38 [-2.78 − 0.02] and -1.01 [-1.92 − -0.10] at intermediate and long term for two studies, respectively. About disability/functional status, SMD [95% CIs] was -0.76 [-1.46 − -0.07] at the intermediate for three studies and MD [95% CIs] was -8.48 [-11.47 − -5.49] at long term for two studies. About fear of physical activity, MD [95% CIs] was -3.01 [-5.14 − -0.88] and -3.56 [-6.43 − -0.68] at intermediate and long term for two studies, respectively. No studies reported scores associated with QOL. All the quality of the evidence was very low. Conclusions Three studies were included and the quality of all the evidence was very low. Although the study found statistically significant differences in some measures, the effectiveness of the CFT will need to be re-evaluated in the future. Trial registration PROSPERO registration number CRD42020158182. Supplementary Information The online version contains supplementary material available at 10.1186/s13030-022-00241-6.
Collapse
Affiliation(s)
- Takahiro Miki
- Sapporo Maruyama Orthopedic Hospital, N7 W 27 Chuo Hokkaido, Sapporo, 006-0007, Japan. .,Faculty of Health Sciences, Hokkaido University, Sapporo, Japan. .,Graduate school, Saitama Prefectural University, Koshigaya, Saitama , Japan.
| | - Yu Kondo
- Sapporo Maruyama Orthopedic Hospital, N7 W 27 Chuo Hokkaido, Sapporo, 006-0007, Japan
| | - Hiroshi Kurakata
- Yumenomachi Home Nursing Care and Rehabilitation Service, Chiba, Japan
| | - Eva Buzasi
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Tsuneo Takebayashi
- Sapporo Maruyama Orthopedic Hospital, N7 W 27 Chuo Hokkaido, Sapporo, 006-0007, Japan
| | - Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Saitama, Japan
| |
Collapse
|
45
|
Ho EKY, Chen L, Simic M, Ashton-James CE, Comachio J, Wang DXM, Hayden JA, Ferreira ML, Ferreira PH. Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis. BMJ 2022; 376:e067718. [PMID: 35354560 PMCID: PMC8965745 DOI: 10.1136/bmj-2021-067718] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the comparative effectiveness and safety of psychological interventions for chronic low back pain. DESIGN Systematic review with network meta-analysis. DATA SOURCES Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, and CINAHL from database inception to 31 January 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials comparing psychological interventions with any comparison intervention in adults with chronic, non-specific low back pain. Two reviewers independently screened studies, extracted data, and assessed risk of bias and confidence in the evidence. Primary outcomes were physical function and pain intensity. A random effects network meta-analysis using a frequentist approach was performed at post-intervention (from the end of treatment to <2 months post-intervention); and at short term (≥2 to <6 months post-intervention), mid-term (≥6 to <12 months post-intervention), and long term follow-up (≥12 months post-intervention). Physiotherapy care was the reference comparison intervention. The design-by-treatment interaction model was used to assess global inconsistency and the Bucher method was used to assess local inconsistency. RESULTS 97 randomised controlled trials involving 13 136 participants and 17 treatment nodes were included. Inconsistency was detected at short term and mid-term follow-up for physical function, and short term follow-up for pain intensity, and were resolved through sensitivity analyses. For physical function, cognitive behavioural therapy (standardised mean difference 1.01, 95% confidence interval 0.58 to 1.44), and pain education (0.62, 0.08 to 1.17), delivered with physiotherapy care, resulted in clinically important improvements at post-intervention (moderate quality evidence). The most sustainable effects of treatment for improving physical function were reported with pain education delivered with physiotherapy care, at least until mid-term follow-up (0.63, 0.25 to 1.00; low quality evidence). No studies investigated the long term effectiveness of pain education delivered with physiotherapy care. For pain intensity, behavioural therapy (1.08, 0.22 to 1.94), cognitive behavioural therapy (0.92, 0.43 to 1.42), and pain education (0.91, 0.37 to 1.45), delivered with physiotherapy care, resulted in clinically important effects at post-intervention (low to moderate quality evidence). Only behavioural therapy delivered with physiotherapy care maintained clinically important effects on reducing pain intensity until mid-term follow-up (1.01, 0.41 to 1.60; high quality evidence). CONCLUSIONS For people with chronic, non-specific low back pain, psychological interventions are most effective when delivered in conjunction with physiotherapy care (mainly structured exercise). Pain education programmes (low to moderate quality evidence) and behavioural therapy (low to high quality evidence) result in the most sustainable effects of treatment; however, uncertainty remains as to their long term effectiveness. Although inconsistency was detected, potential sources were identified and resolved. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019138074.
Collapse
Affiliation(s)
- Emma Kwan-Yee Ho
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Lingxiao Chen
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Milena Simic
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Claire Elizabeth Ashton-James
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Josielli Comachio
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Daniel Xin Mo Wang
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jill Alison Hayden
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Manuela Loureiro Ferreira
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Paulo Henrique Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
46
|
Evaluation of Cognitive Behavioral Therapy on Improving Pain, Fear Avoidance, and Self-Efficacy in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Pain Res Manag 2022; 2022:4276175. [PMID: 35345623 PMCID: PMC8957446 DOI: 10.1155/2022/4276175] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/09/2021] [Accepted: 02/24/2022] [Indexed: 12/24/2022]
Abstract
Background. Cognitive-behavioral therapy (CBT) is commonly adopted in pain management programs for patients with chronic low back pain (CLBP). However, the benefits of CBT are still unclear. Objectives. This review investigated the effectiveness of CBT on pain, disability, fear avoidance, and self-efficacy in patients with CLBP. Methods. Databases including PubMed, EMBASE, Web of Science, Cochrane Library, and PsycINFO were searched. RCTs examining the effects of CBT in adults with CLBP were included. The data about the outcome of pain, disability, fear avoidance, and self-efficacy were retained. Subgroup analysis about the effects of CBT on posttreatment was conducted according to CBT versus control groups (waiting list/usual care, active therapy) and concurrent CBT versus CBT alone. A random-effects model was used, and statistical heterogeneity was explored. Results. 22 articles were included. The results indicated that CBT was superior to other therapies in improving disability (SMD −0.44, 95% CI −0.71 to −0.17,
), pain (SMD −0.32, 95% CI −0.57 to −0.06,
), fear avoidance (SMD −1.24, 95% CI −2.25 to −0.23,
), and self-efficacy (SMD 0.27, 95% CI 0.15 to 0.40,
) after intervention. No different effect was observed between CBT and other therapies in all the follow-up terms. Subgroup analysis suggested that CBT in conjunction with other interventions was in favor of other interventions alone to reduce pain and disability (
). Conclusion. CBT is beneficial in patients with CLBP for improving pain, disability, fear avoidance, and self-efficacy in CLBP patients. Further study is recommended to investigate the long-term benefits of CBT. This meta-analysis is registered with Prospero (registration number CRD42021224837).
Collapse
|
47
|
Schmid S, Bangerter C, Schweinhardt P, Meier ML. Identifying Motor Control Strategies and Their Role in Low Back Pain: A Cross-Disciplinary Approach Bridging Neurosciences With Movement Biomechanics. FRONTIERS IN PAIN RESEARCH 2022; 2:715219. [PMID: 35295522 PMCID: PMC8915772 DOI: 10.3389/fpain.2021.715219] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022] Open
Abstract
Persistent low back pain (LBP) is a major health issue, and its treatment remains challenging due to a lack of pathophysiological understanding. A better understanding of LBP pathophysiology has been recognized as a research priority, however research on contributing mechanisms to LBP is often limited by siloed research within different disciplines. Novel cross-disciplinary approaches are necessary to fill important knowledge gaps in LBP research. This becomes particularly apparent when considering new theories about a potential role of changes in movement behavior (motor control) in the development and persistence of LBP. First evidence points toward the existence of different motor control strategy phenotypes, which are suggested to have pain-provoking effects in some individuals driven by interactions between neuroplastic, psychological and biomechanical factors. Yet, these phenotypes and their role in LBP need further validation, which can be systematically tested using an appropriate cross-disciplinary approach. Therefore, we propose a novel approach, connecting methods from neuroscience and biomechanics research including state-of-the-art optical motion capture, musculoskeletal modeling, functional magnetic resonance imaging and assessments of psychological factors. Ultimately, this cross-disciplinary approach might lead to the identification of different motor control strategy phenotypes with the potential to translate into clinical research for better treatment options.
Collapse
Affiliation(s)
- Stefan Schmid
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christian Bangerter
- Spinal Movement Biomechanics Group, Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Integrative Spinal Research, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Alan Edwards Center for Research on Pain, McGill University, Montreal, QC, Canada
| | - Michael L Meier
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Integrative Spinal Research, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| |
Collapse
|
48
|
Association between depression and anxiety on symptom and function after surgery for lumbar spinal stenosis. Sci Rep 2022; 12:2821. [PMID: 35181747 PMCID: PMC8857319 DOI: 10.1038/s41598-022-06797-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 01/31/2022] [Indexed: 11/09/2022] Open
Abstract
Evidence on the role of depression and anxiety in patients undergoing surgical treatment for symptomatic degenerative lumbar spinal stenosis (DLSS) is conflicting. We aimed to assess the association between depression and anxiety with symptoms and function in patients undergoing surgery for DLSS. Included were patients with symptomatic DLSS participating in a prospective multicentre cohort study who underwent surgery and completed the 24-month follow-up. We used the hospital anxiety and depression scale (HADS) to assess depression/anxiety. We used mixed-effects models to quantify the impact on the primary outcome change in the spinal stenosis measure (SSM) symptoms/function subscale from baseline to 12- and 24-months. Logistic regression analysis was used to quantify the odds of the SSM to reach a minimal clinically important difference (MCID) at 24 months follow-up. The robustness of the results in the presence of unmeasured confounding was quantified using a benchmarking method based on a multiple linear model. Out of 401 patients 72 (17.95%) were depressed and 80 anxious (19.05%). Depression was associated with more symptoms (β = 0.36, 95% confidence interval (CI) 0.20 to 0.51, p < 0.001) and worse function (β = 0.37, 95% CI 0.24 to 0.50, p < 0.001) at 12- and 24-months. Only the association between baseline depression and SSM symptoms/function was robust at 12 and 24 months. There was no evidence for baseline depression/anxiety decreasing odds for a MCID in SSM symptoms and function over time. In patients undergoing surgery for symptomatic DLSS, preoperative depression but not anxiety was associated with more severe symptoms and disability at 12 and 24 months.
Collapse
|
49
|
Schitter AM, Frei P, Elfering A, Kurpiers N, Radlinger L. Evaluation of short-term effects of three passive aquatic interventions on chronic non-specific low back pain: Study protocol for a randomized cross-over clinical trial. Contemp Clin Trials Commun 2022; 26:100904. [PMID: 35243125 PMCID: PMC8886016 DOI: 10.1016/j.conctc.2022.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Low back pain (LBP) is among the most common physical ailments and its chronic manifestation is a leading cause for disability worldwide. LBP is not attributable to a known diagnosis in 85% of the cases and therefore called chronic non-specific LBP (cnLBP). Passive immersion in warm water is commonly claimed to reduce muscular tension and pain, but not yet sufficiently investigated with regard to cnLBP. The current study compares three passive aquatic interventions regarding their effects on cnLBP: floating (resting in a supine immersed position on flotation devices), WATSU (a passive hands-on treatment, in which a practitioner stands in warm water, gently moving and massaging the client), and a Spa session. Methods In this randomized cross-over clinical trial, all 24 adult participants with cnLBP will undergo the three interventions in balanced order with a washout-period of at least two weeks in between. Assessments will take place at baseline and follow-up of study and immediately before and after each intervention. Assessments cover the primary outcome self-reported current pain (Visual Analog Scale, range: 0–100 mm), other self-report questionnaires (addressing, e.g., personality traits or -states), and physiological parameters (e.g., measurement of spinal range of motion). Discussion The study adds estimates of intervention-specific effect-sizes of widespread passive aquatic interventions to cnLBP. The study also points to potential underlying pain-reducing mechanisms. Trial registration The protocol was approved by the Ethics Committee of the Canton Bern (ProjectID: 2018–00461). Trial registration is intended at ClinicalTrials.gov.
Collapse
|
50
|
Bilterys T, Kregel J, Nijs J, Meeus M, Danneels L, Cagnie B, Van Looveren E, Malfliet A. Influence of education level on the effectiveness of pain neuroscience education: A secondary analysis of a randomized controlled trial. Musculoskelet Sci Pract 2022; 57:102494. [PMID: 34953290 DOI: 10.1016/j.msksp.2021.102494] [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] [Received: 03/24/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Current evidence supports the use of pain neuroscience education (PNE) in several chronic pain populations. However, the effects of PNE at group level are rather small and little is known about the influence of personal factors (e.g. level of education [LoE]). OBJECTIVE To examine whether the effectiveness of PNE differs in chronic spinal pain (CSP) patients with high LOE (at least a Bachelor's degree) versus lower educated patients. METHOD A total of 120 Belgian CSP patients were randomly assigned to the experimental (PNE) or control group (biomedical-focused neck/back school). Participants within each group were further subcategorized based on highest achieved LoE. ANOVA and Bonferroni post-hoc analyses were used to evaluate differences in effectiveness of the interventions between higher and lower educated participants. RESULTS No differences between higher and lower educated participants were identified for pain-related disability. Significant interactions (P < .05) were found for kinesiophobia and several illness perceptions components. Bonferroni post-hoc analysis revealed a significant improvement in kinesiophobia (P < .001 and P < .002, medium effect sizes) and perceived negative consequences (P < .001 and P < .008, small effect sizes) in the PNE groups. Only the higher education PNE group showed a significant improvement in perceived illness cyclicity (P = .003, small effect size). Post-treatment kinesiophobia was significant lower in the higher educated PNE group compared to the higher educated control group (p < .001). CONCLUSION Overall, the exploratory findings suggest no clinical meaningful differences in effectiveness of PNE between higher and lower educated people. PNE is effective in improving kinesiophobia and several aspects of illness perceptions regardless of LoE.
Collapse
Affiliation(s)
- Thomas Bilterys
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Jeroen Kregel
- Pain in Motion International Research Group, Belgium(1); Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group, Belgium(1); Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Eveline Van Looveren
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
| | - Anneleen Malfliet
- Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium.
| |
Collapse
|