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Effect of integrated exercise therapy and psychosocial interventions on self-efficacy in patients with chronic low back pain: A systematic review. J Psychosom Res 2023; 165:111126. [PMID: 36610335 DOI: 10.1016/j.jpsychores.2022.111126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/17/2022] [Accepted: 12/19/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Investigate if integrated exercise and psychosocial (EP) interventions effect self-efficacy to manage pain and self-efficacy for physical functioning compared to alternate interventions, usual care, waitlists and attention controls for individuals with chronic low back pain (CLBP). METHODS MEDLINE, Embase, CINAHL, Web of Science, PsychINFO, PEDro, and Cochrane Library were searched. Included randomized controlled trials utilized an EP intervention for CLBP and measured self-efficacy. Independent reviewers screened abstracts, reviewed full-texts, extracted data, and assessed risk of bias. GRADE, synthesis without meta-analysis, and ranges of effects (Hedges' g) were used. RESULTS 2207 Participants were included (22-studies). EP interventions positively effected self-efficacy to manage pain short-term compared to usual care (range of effects: -0.02, 0.94) and controls (range of effects: 0.69, 0.80) and intermediately compared to usual care (range of effects: 0.11, 0.29); however, no differences were found when compared to alternate interventions. EP interventions positively effected self-efficacy for physical functioning short-term compared to alternate interventions (range of effects: 0.57, 0.71), usual care (range of effects: -0.15, 0.94), and controls (range of effects: 0.31, 0.56), and intermediately compared to alternate interventions (1-study, effect: 0.57) and controls (1-study, effect: 0.56). Conclusions were limited by low to very low-quality-evidence often from risk of bias, imprecision, and clinical/statistical heterogeneity. CONCLUSIONS EP interventions may be more effective short-term for self-efficacy to manage pain than usual care and waitlists, but not alternate interventions. EP interventions may be effective for self-efficacy for physical functioning at short- and intermediate-term compared to alternate interventions, usual care, waitlist and attention controls. Considerations for future research include methods for blinding and measurement of self-efficacy for physical functioning.
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Chala MB, Miller J, Ghahari S, Wondie Y, Abebe A, Donnelly C. Health care providers' understanding of self-management support for people with chronic low back pain in Ethiopia: an interpretive description. BMC Health Serv Res 2022; 22:194. [PMID: 35164738 PMCID: PMC8842538 DOI: 10.1186/s12913-022-07610-5] [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: 08/31/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare providers play a key role in supporting people with chronic low back pain to self-manage their condition. The study aimed at exploring how health care providers understand and conceptualize self-management and how they provide self-management support for people with chronic low back pain in Ethiopia. METHODS Health care providers who have supported people with low back pain, including medical doctors and physiotherapists, were approached and recruited from three hospitals in Ethiopia. This study employed an interpretive descriptive approach using semi-structured interviews. FINDINGS Twenty-four participants (7 women; 17 men) with a median age of 28 (range 24 to 42) years and a median of 9.5 years (range 1 to 11 years) of helping people with chronic low back pain were interviewed. Seven major themes related to health care providers' understanding of self-management support for people with chronic low back pain in Ethiopia emerged. The findings show that self-management was a new concept to many and health care providers' had a fragmented understanding of self-management. They used or suggested several self-management support strategies to help people with CLBP self-manage their condition without necessarily focusing on enhancing their self-efficacy skills. The participants also discussed several challenges to facilitate self-management support for people with chronic low back pain. Despite the lack of training on the concept, the providers discussed the potential of providing self-management support for people with the condition. CONCLUSIONS Self-management was a new concept to health care providers. The providers lack the competencies to provide self-management support for people with chronic low back pain. There is a need to enhance the health care providers' self-management support competencies through training.
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Affiliation(s)
- Mulugeta Bayisa Chala
- Queen's University, School of Rehabilitation Therapy, Kingston, ON, Canada. .,Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Jordan Miller
- Queen's University, School of Rehabilitation Therapy, Kingston, ON, Canada
| | - Setareh Ghahari
- Queen's University, School of Rehabilitation Therapy, Kingston, ON, Canada
| | - Yemataw Wondie
- Department of Psychology, College of Social Sciences and Humanities, University of Gondar, Gondar, Ethiopia
| | - Abey Abebe
- Queen's University, School of Rehabilitation Therapy, Kingston, ON, Canada.,Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Catherine Donnelly
- Queen's University, School of Rehabilitation Therapy, Kingston, ON, Canada
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Ferreira-Valente A, Solé E, Sánchez-Rodríguez E, Sharma S, Pathak A, Jensen MP, Miró J, de la Vega R. Does Pain Acceptance Buffer the Negative Effects of Catastrophizing on Function in Individuals With Chronic Pain? Clin J Pain 2021; 37:339-348. [PMID: 33734146 DOI: 10.1097/ajp.0000000000000930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/22/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Pain catastrophizing and pain acceptance are psychological factors that have been shown to be associated with pain-related outcomes and predict multidisciplinary pain treatment outcomes. However, they are rarely examined in the same study. This study aimed to: (1) assess the independent roles of pain catastrophizingand pain acceptance as predictors of pain intensity, pain interference, and depression; and (2) evaluate the potential moderating role of pain acceptance on the association between pain catastrophizing and both pain and function. MATERIALS AND METHODS A sample of 467 adults with chronic pain completed an online survey including measures of pain intensity, pain interference, depression, pain catastrophizing, and pain acceptance. RESULTS Pain catastrophizing and pain acceptance were independent predictors of pain interference. Only pain catastrophizing and the activity engagement domain of pain acceptance were independent predictors of pain intensity and depression. Activity engagement moderated the association between pain catastrophizing and depression, indicating a buffering effect on the negative effects of catastrophizing on depression. Pain willingness moderated the association between pain catastrophizing and pain interference, such that endorsing low pain willingness may override any negative effects of pain catastrophizing. DISCUSSION The findings suggest that pain catastrophizing and pain acceptance are independently important to adjustment to chronic pain. Research is needed to determine if treatments that target both for change are more effective than treatments that target only one.
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Affiliation(s)
- Alexandra Ferreira-Valente
- William James Center for Research, ISPA-Instituto Universitário, Lisbon, Portugal
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Ester Solé
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC)
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia
| | - Elisabet Sánchez-Rodríguez
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC)
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia
| | - Saurab Sharma
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Anupa Pathak
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Jordi Miró
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC)
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia
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Which Interventions Enhance Pain Self-efficacy in People With Chronic Musculoskeletal Pain? A Systematic Review With Meta-analysis of Randomized Controlled Trials, Including Over 12 000 Participants. J Orthop Sports Phys Ther 2020; 50:418-430. [PMID: 32736497 DOI: 10.2519/jospt.2020.9319] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To find out which interventions enhance pain self-efficacy in people with chronic musculoskeletal pain and to evaluate the reporting of interventions designed to enhance pain self-efficacy. DESIGN Intervention systematic review with meta-analysis. LITERATURE SEARCH PubMed, Embase, Scopus, PsycINFO, CINAHL, PEDro, and the Cochrane Central Register of Controlled Trials were searched from inception up to September 2019. STUDY SELECTION CRITERIA Randomized controlled trials evaluating pain self-efficacy as a primary or secondary outcome in chronic musculoskeletal pain. DATA SYNTHESIS We used the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the risk of bias and the certainty of the evidence, respectively. RESULTS Sixty randomized controlled trials were included (12 415 participants). There was a small effect of multicomponent, psychological, and exercise interventions improving pain self-efficacy at follow-ups of 0 to 3 months, a small effect of exercise and multicomponent interventions enhancing pain self-efficacy at follow-ups of 4 to 6 months, and a small effect of multicomponent interventions improving pain self-efficacy at follow-ups of 7 to 12 months. No interventions improved pain self-efficacy after 12 months. Self-management interventions did not improve pain self-efficacy at any follow-up time. Risk of bias, the nature of the control group, and the instrument to assess pain self-efficacy moderated the effects of psychological therapies at follow-ups of 7 to 12 months. The certainty of the evidence for all included interventions was low, due to serious risk of bias and indirectness. No trial reported the intervention in sufficient detail to allow full replication. CONCLUSION There was low-quality evidence of a small effect of multicomponent exercise and psychological interventions improving pain self-efficacy in people with chronic musculoskeletal pain. J Orthop Sports Phys Ther 2020;50(8):418-430. doi:10.2519/jospt.2020.9319.
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Joypaul S, Kelly F, McMillan SS, King MA. Multi-disciplinary interventions for chronic pain involving education: A systematic review. PLoS One 2019; 14:e0223306. [PMID: 31577827 PMCID: PMC6774525 DOI: 10.1371/journal.pone.0223306] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There have been growing recommendations to include education in multi-disciplinary interventions targeting chronic pain management. However, effects of this strategy on short- and long-term self-management of chronic pain, remain largely unexplored. OBJECTIVES 1. To provide an updated overview of studies that report on the impact of patient education in multi-disciplinary interventions, on self-management of chronic pain; 2. To explore associations between education and chronic pain self-management techniques; and 3. To identify the format and duration of suitable chronic pain interventions targeted at patient self-management. METHODS Design: Narrative systematic literature review of randomised or controlled study designs. Data Sources: PubMed, CINAHL, EMBASE, PsycINFO. Participants: Adult patients with chronic pain of any aetiology participating in multi-disciplinary programs that included education. Main outcome measures: Assessments of level of pain, function, quality of life, self-efficacy, self-management, and any other relevant assessments. Study Appraisal and Synthesis Methods: PRISMA guidelines, Cochrane Risk of Bias tool, and TIDieR model. RESULTS Database searching identified 485 potential papers. After removal of duplicates, and irrelevant articles by title and abstract, 120 full-text articles were reviewed and 27 studies were included in this systematic review. Studies were predominantly from the United States (n = 8; 29.6%). Over one hundred outcome measures were identified across all studies, with significant variation also observed in terms of how chronic pain duration was defined, and how education was delivered to participants. Overall, positive benefits of education were reported. CONCLUSIONS Education, as part of multi-disciplinary programs, is likely to improve self-management and self-efficacy in people with chronic pain of any aetiology. Heterogeneity in terms of: chronic pain duration; educational resources; healthcare professionals; and outcome measures, were identified as limitations. Further research, in the form of Randomised Controlled Trials addressing these limitations, is recommended.
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Affiliation(s)
- Shirdhya Joypaul
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Fiona Kelly
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Sara S. McMillan
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Michelle A. King
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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Parfenov VA, Yakhno NN, Davydov OS, Kukushkin ML, Churyukanov MV, Golovacheva VA, Isaikin AI, Achkasov EE, Evzikov GY, Karateev AE, Khabirov FA, Shirokov VA, Yakupov EZ. Chronic nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2019. [DOI: 10.14412/2074-2711-2019-2s-7-16] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Examination of a patient with chronic low back pain (LBP) is aimed at eliminating its specific cause and assessing the social and psychological factors of chronic pain. The diagnosis of chronic nonspecific (musculoskeletal) LBP is based on the exclusion of a specific cause of pain, discogenic radiculopathy, and lumbar stenosis. It is advisable to identify possible pain sources: pathology of intervertebral disc pathology, facet joints, and sacroiliac joint and myofascial syndrome.An integrated multidisciplinary approach (a high level of evidence), including therapeutic exercises, physical activity optimization, psychological treatments (cognitive behavioral therapy), an educational program (back pain school for patients), and manual therapy, is effective in treating chronic musculoskeletal LBP. For pain relief, one may use nonsteroidal anti-inflammatory drugs in minimally effective doses and in a short cycle, muscle relaxants, and a capsaicin patch, and, if there is depressive disorder, antidepressants (a medium level of evidence). Radiofrequency denervation or therapeutic blockages with anesthetics and glucocorticoids (damage to the facet joints, sacroiliac joint), back massage, and acupuncture (a low level of evidence) may be used in some patients.Therapeutic exercises and an educational program (the prevention of excessive loads and prolonged static and uncomfortable postures and the use of correct methods for lifting weights, etc.) are recommended for preventive purposes.
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Affiliation(s)
- V. A. Parfenov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - N. N. Yakhno
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - O. S. Davydov
- Z.P. Solovyev Research and Practical Center of Psychoneurology, Moscow Healthcare Department
| | - M. L. Kukushkin
- Research Institute of General Pathology and Pathophysiology, Russian Academy of Sciences
| | - M. V. Churyukanov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia; Acad. B.V. Petrovsky Russian Research Center of Surgery
| | - V. A. Golovacheva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - A. I. Isaikin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - E. E. Achkasov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - G. Yu. Evzikov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | | | - F. A. Khabirov
- Kazan State Medical Academy, Branch, Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - V. A. Shirokov
- Ural State Medical University, Ministry of Health of Russia
| | - E. Z. Yakupov
- Kazan State Medical University, Ministry of Health of Russia
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Alfuth M, Welsink DW. Pain and functional outcomes after outpatient physiotherapy in patients with low back pain. DER ORTHOPADE 2017; 46:522-529. [PMID: 28204835 DOI: 10.1007/s00132-017-3390-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Physiotherapy treatment programs are recommended in the rehabilitation of low back pain (LBP). Rehabilitation institutions are increasingly asked to demonstrate the outcomes of their intensive physiotherapy services. AIM To describe pain and functional outcome measures following a 6-month outpatient physiotherapy treatment program in patients with LBP. METHODS A total of 85 patients were analysed after being treated with a combination of physiotherapeutic treatment modalities 2-3 days weekly. Pain and disability were measured before, 3 and 6 months after the onset of treatment. Isometric trunk muscle strength for flexion and extension and flexibility of dorsal trunk and thigh structures were measured before and 6 months after treatment. RESULTS After 6 months, pain at rest decreased from a median of 4.0 to 0.0 (p < 0.01) and pain during activity from a median of 5.5 to 2.0 on the numeric rating scale (p < 0.001). The Roland-Morris Disability (RMDQ) score decreased from a median of 7.0 to 3.0 (p < 0.001). Mean trunk muscle flexion strength increased from 133.7 to 156.0 Nm and for extension from 235.5 to 278.3 Nm (p < 0.001). Flexibility was improved from a mean of -5.9 to -1.4 cm (p < 0.001). A moderate correlation between pain at rest and RMDQ score was found after 3 (r = 0.532, p < 0.01) and 6 months (r = 0.508, p < 0.01). CONCLUSIONS Patients with LBP who were treated with the physiotherapeutic treatment program showed a clinically relevant reduction of pain and disability with improved trunk muscle strength and flexibility. Reductions in pain and disability do not seem to correlate with increased trunk muscle strength and flexibility. No conclusions can be declared about long-term changes after the intervention.
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Affiliation(s)
- Martin Alfuth
- Faculty of Health Care (Therapeutic Sciences), Niederrhein University of Applied Sciences, Reinarzstr. 49, 47805, Krefeld, Germany.
| | - Dieter W Welsink
- medicoreha Welsink Rehabilitation GmbH, Ambulante Fachkliniken für Rehabilitation, Preußenstr. 84a, 41464, Neuss, Germany
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Du S, Hu L, Dong J, Xu G, Chen X, Jin S, Zhang H, Yin H. Self-management program for chronic low back pain: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2017; 100:37-49. [PMID: 27554077 DOI: 10.1016/j.pec.2016.07.029] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the effectiveness of self-management programs (SMPs) on chronic low back pain (CLBP). METHODS A search of randomized controlled trials (RCTs) was performed in Pubmed, Cochrane Library, Web of Science, Elsevier, and CINAHL through June, 2015. Two reviewers selected trials, conducted critical appraisal, and extracted data. Meta analyses were performed. RESULTS Thirteen moderate-quality RCTs were included. There were 9 RCTs for immediate post intervention on pain intensity and disability, 5 RCTs for short term, 3 RCTs for intermediate and 4 RCTs for long term. Specifically, the effect sizes (ESs) of SMP on pain intensity were -0.29, -0.20, -0.23, and -0.25 at immediate post-intervention, short-term, intermediate-term, and long-term follow-ups, respectively. The ESs on disability were -0.28, -0.23, -0.19, and -0.19 at immediate post-intervention, short-term, intermediate-term, and long-term follow-ups, respectively. CONCLUSION For CLBP patients, there is moderate-quality evidence that SMP has a moderate effect on pain intensity, and small to moderate effect on disability. PRACTICE IMPLICATIONS SMP can be regarded as an effective approach for CLBP management. In addition to face-to-face mode, internet-based strategy can also be considered as a useful option to deliver SMP. Theoretically driven programs are preferred.
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Affiliation(s)
- Shizheng Du
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China
| | - Lingli Hu
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Jianshu Dong
- Shanghai Health Education Institute, 358 Jiaozhou Road Building B, Jing'an District, Shanghai, 200040, China
| | - Guihua Xu
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China.
| | - Xuan Chen
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China
| | - Shengji Jin
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China
| | - Heng Zhang
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China
| | - Haiyan Yin
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province, 210023, China
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Trott M, Fisher K. Using Video Assessment for Clients with Chronic Low Back Pain: Is it Reliable? Br J Occup Ther 2016. [DOI: 10.1177/030802260506801202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clients with chronic back pain can benefit from learning strategies to manage their pain. In a 3-week pain management programme, the use of a videotaped assessment on admission and at discharge enables occupational therapists to score functional movement, as well as providing visual feedback for the clients, although evidence of reliability is necessary. This study investigated the reliability of intrarater and interrater scoring between four experienced occupational therapists who scored the video assessment. Forty clients and forty controls were chosen to complete the assessment. The assessment consists of tasks with 59 different items to score. Each task is scored on three factors: posture, problem solving and movement. The results demonstrated that interrater reliability for problem solving was not consistent. However, it was consistent for posture and movement in the client group, although less so for controls, showing increased difficulty in identifying the more subtle principles being used. Intrarater reliability was less convincing, with the therapist reporting fatigue at the number of items to be scored. However, this could be improved by reducing the number of items in the assessment because analysis showed that 39% of items did not meet the criteria for statistical significance of change. More clarification on the score measures will assist in measuring the efficacy of the treatment programme objectively. Discriminant validity of the scoring system was indicated by the improvement seen in the clients' performance but not in that of the controls. Further studies to improve reliability and demonstrate better validity are planned.
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Taylor SJC, Carnes D, Homer K, Pincus T, Kahan BC, Hounsome N, Eldridge S, Spencer A, Diaz-Ordaz K, Rahman A, Mars TS, Foell J, Griffiths CJ, Underwood MR. Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS). PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BackgroundChronic musculoskeletal pain is a common problem that is difficult to treat. Self-management support interventions may help people to manage this condition better; however, there is limited evidence showing that they improve clinical outcomes. Our overarching research question was ‘Does a self-management support programme improve outcomes for people living with chronic musculoskeletal pain?’.AimTo develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically grounded self-management support intervention for people living with chronic musculoskeletal pain.MethodsIn phase 1 we carried out two systematic reviews to synthesise the evidence base for self-management course content and delivery styles likely to help those with chronic pain. We also considered the psychological theories that might underpin behaviour change and pain management principles. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in Self-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session after 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with experience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the literature on potential outcome domains and measures and consulted widely with patients, tutors and experts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English and, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community. In phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of adding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain toolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and musculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire. We collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs, health utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression Scale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by participants were extracted from NHS electronic records.ResultsWe recruited 703 participants with a mean age of 60 years (range 19–94 years); 81% were white and 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and anxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants received 85% of the course content. At 12 months there was no difference between treatment groups in our primary outcome of pain-related disability [difference –1.0 intervention vs. control, 95% confidence interval (CI) –4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration all improved more in the intervention group at 6 months. At 1 year these differences remained for depression (–0.7, 95% CI –1.2 to –0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS intervention had a high probability (87%) of being cost-effective compared with usual care at a threshold of £30,000 per quality-adjusted life-year.ConclusionsAlthough the COPERS intervention did not affect our primary outcome of pain-related disability, it improved psychological well-being and is likely to be cost-effective according to current National Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a substitute for less well-evidenced (and more expensive) pain self-management programmes. Effective interventions to improve hard outcomes in chronic pain patients, such as disability, are still needed.Trial registrationCurrent Controlled Trials ISRCTN22714229.FundingThe project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stephanie JC Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Brennan C Kahan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natalia Hounsome
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anne Spencer
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Karla Diaz-Ordaz
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anisur Rahman
- Department of Rheumatology, University College Hospital, University College London, London, UK
| | - Tom S Mars
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jens Foell
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin R Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Fisher K, Oliver S, Sedki I, Hanspal R. The effect of electromagnetic shielding on phantom limb pain: A placebo-controlled double-blind crossover trial. Prosthet Orthot Int 2016; 40:350-6. [PMID: 25716957 DOI: 10.1177/0309364614568409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 11/21/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Environmental electromagnetic fields influence biological systems. Evidence suggests these have a role in the experience of phantom limb pain in patients with amputations. OBJECTIVES This article followed a previous study to investigate the effect of electromagnetic field shielding with a specially designed prosthetic liner. STUDY DESIGN Randomised placebo-controlled double-blind crossover trial. METHODS Twenty suitable participants with transtibial amputations, phantom pain at least 1 year with no other treatable cause or pathology were requested to record daily pain, well-being, activity and hours of prosthetic use on pre-printed diary sheets. These were issued for three 2-week periods (baseline, electromagnetic shielding (verum) and visually identical placebo liners - randomly allocated). RESULTS Thirty-three per cent of the recruited participants were unable to complete the trial. The resulting N was therefore smaller than was necessary for adequate power. The remaining data showed that maximum pain and well-being were improved from baseline under verum but not placebo. More participants improved on all variables with verum than placebo. CONCLUSION Electromagnetic field shielding produced beneficial effects in those participants who could tolerate the liner. It is suggested that this might be due to protection of vulnerable nerve endings from nociceptive effects of environmental electromagnetic fields. CLINICAL RELEVANCE Electromagnetic field shielding with a suitable limb/prosthesis interface can be considered a useful technique to improve pain and well-being in patients with phantom limb pain.
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Affiliation(s)
- Keren Fisher
- The Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Imad Sedki
- The Royal National Orthopaedic Hospital, Stanmore, UK
| | - Rajiv Hanspal
- The Royal National Orthopaedic Hospital, Stanmore, UK
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Effectiveness of multidisciplinary rehabilitation treatment for patients with chronic pain in a primary health care unit. Scand J Pain 2013; 4:190-197. [PMID: 29913651 DOI: 10.1016/j.sjpain.2013.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
Background In recent years, multidisciplinary rehabilitation (MDR) became an alternative treatment option for chronic non-cancer pain. MDR is mostly available in specialized pain units, usually at rehabilitation centers where the level of knowledge and therapeutically options to treat pain conditions are considered to be high. There is strong evidence that MDR in specialized pain units is affecting pain and improves the quality of life in a sustainable manner. There are few studies about MDR outcome in primary health care, especially in those units situated in rural areas and with a different population than that encountered in specialized hospitals. That, in spite of the fact that the prevalence of pain in the patients treated in primary care practice is about 30%. The aim of this study is to analyze the effectiveness of MDR for chronic non-cancer patients in a primary health care unit. Methods This study included a total of 51 patients with chronic pain conditions who were admitted and completed the local MDR-program at the primary health care unit in Arvika, Sweden. The major complaint categories were fibromyalgia (53%), pain from neck and shoulder (28%) or low back pain (12%). The inclusion criteria were age between 16 and 67 years and chronic non-cancer pain with at least 3 months duration. The multidisciplinary team consisted of a general practitioner, two physiotherapists, two psychologists and one occupational therapist. The 6-week treatment took place in group sessions with 6-8 members each and included cognitive-behavioral treatment, education on pain physiology, ergonomics, physical exercises and relaxation techniques. Primary outcomes included pain intensity, pain severity, anxiety and depression scores, social and physical activity, and secondary outcomes were sick leave, opioid consumption and health care utilization assessed in the beginning of the treatment and at one year follow-up. Data was taken from the Swedish Quality Register for Pain Rehabilitation (SQRP) and the patients' medical journal. Results One year after MDR treatment, sick leave decreased from 75.6% to 61.5% (p <0.05). Utilization of health-care during one year decreased significantly from 27.4 to 20.1 contacts (p = 0.02). There were significant improvements concerning social activity (p = 0.03) and depression (p <0.05), but not in anxiety (p = 0.1) and physical activity (p = 0.08). Although not statistically significant, some numerical decrease in the mean levels of pain intensity, pain severity and opioid consumption were reported one year after MDR (p > 0.05). Conclusions The results obtained one year after rehabilitation indicated that patients with chronic noncancer pain might benefit from MDR in primary health care settings. Implications This study suggests that MDR in primary care settings as well as MDR at specialized pain units may lead to better coping in chronic non-cancer pain conditions with lower depression scores and higher social activity, leading to lower sick leave. This study demonstrated that there is a place for MDR in primary health care units with the given advantage of local intervention in rural areas allowing the patients to achieve rehabilitation in their home environment.
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Mediators of yoga and stretching for chronic low back pain. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:130818. [PMID: 23690832 PMCID: PMC3652191 DOI: 10.1155/2013/130818] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/14/2013] [Indexed: 11/30/2022]
Abstract
Although yoga is an effective treatment for chronic low back pain, little is known about the mechanisms responsible for its benefits. In a trial comparing yoga to intensive stretching and self-care, we explored whether physical (hours of back exercise/week), cognitive (fear avoidance, body awareness, and self-efficacy), affective (psychological distress, perceived stress, positive states of mind, and sleep), and physiological factors (cortisol, DHEA) mediated the effects of yoga or stretching on back-related dysfunction (Roland-Morris Disability Scale (RDQ)). For yoga, 36% of the effect on 12-week RDQ was mediated by increased self-efficacy, 18% by sleep disturbance, 9% by hours of back exercise, and 61% by the best combination of all possible mediators (6 mediators). For stretching, 23% of the effect was mediated by increased self-efficacy, 14% by days of back exercise, and 50% by the best combination of all possible mediators (7 mediators). In open-ended questions, ≥20% of participants noted the following treatment benefits: learning new exercises (both groups), relaxation, increased awareness, and the benefits of breathing (yoga), benefits of regular practice (stretching). Although both self-efficacy and hours of back exercise were the strongest mediators for each intervention, compared to self-care, qualitative data suggest that they may exert their benefits through partially distinct mechanisms.
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Effective delivery styles and content for self-management interventions for chronic musculoskeletal pain: a systematic literature review. Clin J Pain 2012; 28:344-54. [PMID: 22001667 DOI: 10.1097/ajp.0b013e31822ed2f3] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of the study was to report the evidence for effectiveness of different self-management course characteristics and components for chronic musculoskeletal pain. METHODS We searched 9 relevant electronic databases for randomized, controlled trials (RCTs). Two reviewers selected studies against inclusion criteria and assessed their quality. We classified RCTs according to type of course delivery (group, individual, mixed or remote), tutor (healthcare professional, lay or mixed), setting (medical, community or occupational), duration (more or less than 8 weeks), and the number and type of components (psychological, lifestyle, pain education, mind body therapies, and physical activity). We extracted data on pain intensity, physical function, self-efficacy, global health, and depression and compared these outcomes for self-management and usual care or waiting list control. We used random effects standardized mean difference meta-analysis. We looked for patterns of clinically important and statistically significant beneficial effects for courses with different delivery characteristics and the presence or absence of components across outcomes over 3 follow-up intervals. RESULTS We included 46 RCTs (N=8539). Group-delivered courses that had healthcare professional input showed more beneficial effects. Longer courses did not necessarily give better outcomes. There was mixed evidence of effectiveness for components of courses, but data for courses with a psychological component showed slightly more consistent beneficial effects over each follow-up period. DISCUSSION Serious consideration should be given to the development of short (<8 weeks) group and healthcare professional-delivered interventions but more research is required to establish the most effective and cost-effective course components.
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Abstract
BACKGROUND Graded activity and graded exposure are increasingly being used in the management of persistent low back pain; however, their effectiveness remains poorly understood. PURPOSE The aim of this study was to systematically review randomized controlled trials that evaluated the effectiveness of graded activity or graded exposure for persistent (>6 weeks in duration or recurrent) low back pain. DATA SOURCES Trials were electronically searched and rated for quality by use of the PEDro scale (values of 0-10). STUDY SELECTION Randomized controlled trials of graded activity or graded exposure that included pain, disability, global perceived effect, or work status outcomes were included in the study. DATA EXTRACTION Outcomes were converted to a scale from 0 to 100. Trials were pooled with software used for preparing and maintaining Cochrane reviews. RESULTS are presented as weighted mean differences with 95% confidence intervals. DATA SYNTHESIS Fifteen trials with 1,654 patients were included. The trials had a median quality score of 6 (range=3-9). Pooled effects from 6 trials comparing graded activity with a minimal intervention or no treatment favored graded activity, with 4 contrasts being statistically significant: mean values (95% confidence intervals) for pain in the short term, pain in the intermediate term, disability in the short term, and disability in the intermediate term were -6.2 (-9.4 to -3.0), -5.5 (-9.9 to -1.0), -6.5 (-10.1 to -3.0), and -3.9 (-7.4 to -0.4), respectively. None of the pooled effects from 6 trials comparing graded activity with another form of exercise, from 4 trials comparing graded activity with graded exposure, and from 2 trials comparing graded exposure with a waiting list were statistically significant. LIMITATIONS Limitations of this review include the low quality of the studies, primarily those that evaluated graded exposure; the use of various types of outome measures; and differences in the implementation of the interventions, adding to the heterogeneity of the studies. CONCLUSIONS The available evidence suggests that graded activity in the short term and intermediate term is slightly more effective than a minimal intervention but not more effective than other forms of exercise for persistent low back pain. The limited evidence suggests that graded exposure is as effective as minimal treatment or graded activity for persistent low back pain.
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Fisher K. Assessing clinically meaningful change following a programme for managing chronic pain. Clin Rehabil 2007; 22:252-9. [DOI: 10.1177/0269215507081928] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: (1) To identify criteria for clinically meaningful change scores in commonly used measures of pain and related disability, using Goal Attainment Scaling as an external indicator of success. (2) To investigate the chances of achieving these scores following a pain management programme versus remaining on the waiting list. Design: Participants were assessed on entry to waiting list, on admission and at follow-up from the pain management programme. Three groups of Goal Attainment Scaling scores (-1.0, +1) were created from final Goal Attainment Scaling achievements. Mean scores on other measures were analysed in relation to Goal Attainment Scaling score groups by ANOVA. Differences in numbers achieving clinically meaningful changes when on the pain management programme or waiting list were compared. Subjects: Chronic musculoskeletal pain participants (N = 73) attending a rehabilitation centre, mean age (range) 44.8 (24—70) years, mean age (range) 44.8 (24—70), mean pain duration 7.7 (1—32) years. Intervention: Three-week (15-day) pain management programme based on cognitive behavioural principles. Measures: McGill Pain Questionnaire, 0—10 Pain Intensity Numerical Rating Scale (NRS), Oswestry Disability Questionnaire (ODQ), General Health Questionnaire (GHQ), 5 minute walk, 1 minute sit/stand, 1 minute stair-climbing, and Goal Attainment Scaling (GAS). Results: Mean change scores differed significantly for three GAS groups and were highest in the most successful (+1) group. These scores were used to define clinically meaningful changes on the NRS (-3), ODQ (-12), walk (+87) and stairs (+14). Significantly more participants on the pain management programme achieved these scores than those on the waiting list. Conclusion: Using GAS as a criterion of patient-perceived improvement enabled identification of clinically meaningful changes on some other common measures. These successfully differentiated achievement between patients on the pain management programme and those on the waiting list.
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Recommandations européenes (COST B 13) en matiè de prévention et de prise en charge de la lombalgie non spécifique. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1169-8330(06)80002-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fisher K, Hardie RJ. Goal attainment scaling in evaluating a multidisciplinary pain management programme. Clin Rehabil 2002; 16:871-7. [PMID: 12501949 DOI: 10.1191/0269215502cr554oa] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the value of Goal Attainment Scaling (GAS) as a therapeutic tool and an outcome measure in a rehabilitation programme in the management of chronic pain. DESIGN A prospective observational study. SETTING A 15-day pain management programme, day case or residential, in an NHS Regional rehabilitation centre. SUBJECTS One hundred and forty-nine consecutive patients enrolled during a 15-month period. INTERVENTIONS Multidisciplinary structured educational programme of physiotherapy, occupational therapy and clinical psychology. MAIN OUTCOME MEASURES GAS; timed tests of physical mobility measures; McGill Pain Questionnaire (MPQ); Pain Intensity Numerical Rating Scale (NRS); Oswestry low back pain Disability Questionnaire (ODQ); General Health Questionnaire (GHQ); Pain and Impairment Relationship Scale (PAIRS). GAS and physiotherapy measures were compared with baseline data at enrollment and at discharge 15 days later. At six-month follow-up all measures were repeated. RESULTS Significant improvements at discharge were found for GAS, and physiotherapy measures. One hundred and twelve patients returned for review at six months, when improvements were maintained for GAS, sit/stand, Pain, ODQ and GHQ. GAS was shown to be a valid measure of ability, correlating significantly with walking improvement and somewhat less with a therapist-defined measure, suggesting some ability to discriminate. CONCLUSIONS The improvement measured by GAS showed that patients were enabled by the programme to achieve personally valued goals over a six-month period and to improve on these more than on other more conventional outcome measures.
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Affiliation(s)
- K Fisher
- Wolfson Neurorehabilitation Centre, Atkingson Morley's Hospital, London, UK
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Keller S, Herda C, Ridder K, Basler HD. Readiness to adopt adequate postural habits: an application of the Transtheoretical Model in the context of back pain prevention. PATIENT EDUCATION AND COUNSELING 2001; 42:175-184. [PMID: 11118783 DOI: 10.1016/s0738-3991(00)00103-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Based on a biomechanical model, an adequate body posture can contribute to the prevention of back pain and back pain chronicity. This study examines the explanatory value of the Transtheoretical Model (TTM) for the adoption of adequate postural habits in a cross-sectional sample of 149 employees of a German administration unit (mean age 40.2 years, 50% female). Using newly developed instruments with satisfactory psychometric properties, basic assumptions of the TTM could be confirmed: self-efficacy and the perceived pros for maintaining a good body posture increased significantly across the stages, while the perceived cons decreased. Additionally, the use of preventive strategies for back pain prevention increased linearly and significantly across the stages of change. The study supports the applicability of the TTM for postural behavior. Considering stages of change as an intervening variable may contribute to clarifying the relationship between participation in low back schools and prevention of back pain chronicity. Longitudinal and intervention study data are needed to support these assumptions.
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Affiliation(s)
- S Keller
- Institute for Medical Psychology, University of Marburg, Bunsenstr. 3, 35033 Marburg, Germany.
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Abstract
Outcome studies evaluating psychological treatments for pain vary in nature and intensity. Overall, however, treatment programs that include psychological interventions have been shown to be effective in treating postoperative pain, noncardiac chest pain, fibromyalgia syndrome, and chronic back pain. Cost analyses of the treatments indicate not only the clinical efficacy but the cost-effectiveness of psychological interventions. Issues related to subject attrition, noncompliance, and individual differences in treatment response should be addressed in future studies.
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Affiliation(s)
- D C Turk
- Department of Anesthesiology, University of Washington, Seattle, Washington 98195, USA
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