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van de Wijdeven B, Visser B, Kuijer PPFM. Evaluating the categorisation of interventions in individual working practice aimed at preventing work-related musculoskeletal disorders: An international experts consultation. APPLIED ERGONOMICS 2024; 120:104338. [PMID: 38968738 DOI: 10.1016/j.apergo.2024.104338] [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: 02/21/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 07/07/2024]
Abstract
In a previous scoping review, eight categories of interventions in individual work practice were defined. The aim of the present study is to evaluate the relevance and completeness of these eight categories and to increase the clarity of the nomenclature and definitions of each category. An international expert consultation has been carried out for this purpose. Thirty-eight experts from 13 countries participated. Data collection was conducted using a survey design comprising structured questions. Consensus was reached if 75% of the experts answered 'Strongly agree' or 'Agree' on a 5-point Likert scale. For the topic 'Relevance', there was consensus for six of the eight categories (range 78%-86%), the exceptions were the categories: 'Exercising' (72%) and 'Professional manners' (64%). With regard to the topic 'Nomenclature', consensus was reached for six categories and for the topic 'Definition' this was five categories. The present definitions have been improved based on the expert recommendations. With respect to the topic 'Completeness': although a limited number of suggestions were given, this did not lead to one or more categories being added to the existing eight categories. The final 'Nomenclature' for the categories is: 'Variation', 'Professional behaviour', 'Motoric skills', 'Vocational working techniques', 'Physical workplace', 'Physical training', 'Assistive devices and tools' and 'Task content and task organisation'. This expert consultation has provided a solid basis for endorsing the categorisation of interventions in IWP and is an important step in building a framework to develop and evaluate interventions in IWP.
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Affiliation(s)
- Bert van de Wijdeven
- Amsterdam UMC Location University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Bart Visser
- Centre of Expertise Urban Vitality, Amsterdam University of Applied SCs, Amsterdam, the Netherlands.
| | - P Paul F M Kuijer
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
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2
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Chamoro M, Heymans MW, Oei EH, Bierma-Zeinstra SM, Koes BW, Chiarotto A. Diagnostic models to predict structural spinal osteoarthritis on lumbar radiographs in older adults with back pain: Development and internal validation. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100506. [PMID: 39183945 PMCID: PMC11342188 DOI: 10.1016/j.ocarto.2024.100506] [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: 07/17/2024] [Accepted: 07/21/2024] [Indexed: 08/27/2024] Open
Abstract
Objective It is difficult for health care providers to diagnose structural spinal osteoarthritis (OA), because current guidelines recommend against imaging in patients with back pain. Therefore, the aim of this study was to develop and internally validate multivariable diagnostic prediction models based on a set of clinical and demographic features to be used for the diagnosis of structural spinal OA on lumbar radiographs in older patients with back pain. Design Three diagnostic prediction models, for structural spinal OA on lumbar radiographs (i.e. multilevel osteophytes, multilevel disc space narrowing (DSN), and both combined), were developed and internally validated in the 'Back Complaints in Older Adults' (BACE) cohort (N = 669). Model performance (i.e. overall performance, discrimination and calibration) and clinical utility (i.e. decision curve analysis) were assessed. Internal validation was performed by bootstrapping. Results Mean age of the cohort was 66.9 years (±7.6 years) and 59% were female. All three models included age, gender, back pain duration and duration of spinal morning stiffness as predictors. The combined model additionally included restricted lateral flexion and spinal morning stiffness severity, and exhibited the best model performance (optimism adjusted c-statistic 0.661; good calibration with intercept -0.030 and slope of 0.886) and acceptable clinical utility. The other models showed suboptimal discrimination, good calibration and acceptable decision curves. Conclusion All three models for structural spinal OA displayed lesuboptimal discrimination and need improvement. However, these internally validated models have potential to inform primary care clinicians about a patient with risk of having structural spinal OA on lumbar radiographs. External validation before implementation in clinical care is recommended.
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Affiliation(s)
- Mirna Chamoro
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Edwin H.G. Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sita M.A. Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bart W. Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Research Unit of General Practice, Department of Public Health & Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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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; 25:104526. [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] [MESH Headings] [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.
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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
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4
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Eldabe S, Nevitt S, Bentley A, Mekhail NA, Gilligan C, Billet B, Staats PS, Maden M, Soliday N, Leitner A, Duarte RV. Network Meta-analysis and Economic Evaluation of Neurostimulation Interventions for Chronic Nonsurgical Refractory Back Pain. Clin J Pain 2024; 40:507-517. [PMID: 38751011 PMCID: PMC11309338 DOI: 10.1097/ajp.0000000000001223] [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: 03/12/2024] [Accepted: 04/16/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES Different types of spinal cord stimulation (SCS) have been evaluated for the management of chronic nonsurgical refractory back pain (NSRBP). A direct comparison between the different types of SCS or between closed-loop SCS with conventional medical management (CMM) for patients with NSRBP has not been previously conducted, and therefore, their relative effectiveness and cost-effectiveness remain unknown. The aim of this study was to perform a systematic review, network meta-analysis (NMA) and economic evaluation of closed-loop SCS compared with fixed-output SCS and CMM for patients with NSRBP. METHODS Databases were searched to September 8, 2023. Randomized controlled trials of SCS for NSRBP were included. The results of the studies were combined using fixed-effect NMA models. A cost-utility analysis was performed from the perspective of the UK National Health Service with results reported as incremental cost per quality-adjusted life-year (QALY). RESULTS Closed-loop SCS resulted in statistically and clinically significant reductions in pain intensity (mean difference [MD] 32.72 [95% CrI 15.69-49.78]) and improvements in secondary outcomes (Oswestry Disability Index [ODI] and health-related quality of life [HRQoL]) compared with fixed-output SCS at 6-month follow-up. Compared with CMM, both closed-loop and fixed-output SCS resulted in statistically and clinically significant reductions in pain intensity (closed-loop SCS vs. CMM MD 101.58 [95% CrI 83.73-119.48]; fixed-output SCS versus CMM MD 68.86 [95% CrI 63.43-74.31]) and improvements in secondary outcomes (ODI and HRQoL). Cost-utility analysis showed that closed-loop SCS dominates fixed-output SCS and CMM, and fixed-output SCS also dominates CMM. DISCUSSION Current evidence showed that closed-loop and fixed-output SCS provide more benefits and cost-savings compared with CMM for patients with NSRBP.
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Affiliation(s)
- Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough
| | - Sarah Nevitt
- Centre for Reviews and Dissemination, University of York, York
| | | | - Nagy A. Mekhail
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, OH
| | | | | | | | - Michelle Maden
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Nicole Soliday
- Saluda Medical Pty Ltd., Artarmon, New South Wales, Australia
| | - Angela Leitner
- Saluda Medical Pty Ltd., Artarmon, New South Wales, Australia
| | - Rui V. Duarte
- Department of Health Data Science, University of Liverpool, Liverpool, UK
- Saluda Medical Pty Ltd., Artarmon, New South Wales, Australia
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Dhiman MS, Bader TJ, Ponjevic D, Salo PT, Hart DA, Swamy G, Matyas JR, Duncan NA. Collagen integrity of the annulus fibrosus in degenerative disc disease individuals quantified with collagen hybridizing peptide. JOR Spine 2024; 7:e1359. [PMID: 39092166 PMCID: PMC11291301 DOI: 10.1002/jsp2.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/27/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction Degenerative disc disease (DDD) is accompanied by structural changes in the intervertebral discs (IVD). Extra-cellular matrix degradation of the annulus fibrosus (AF) has been linked with degeneration of the IVD. Collagen is a vital component of the IVD. Collagen hybridizing peptide (CHP) is an engineered protein that binds to degraded collagen, which we used to quantify collagen damage in AF. This method was used to compare AF samples obtained from donors with no DDD to AF samples from patients undergoing surgery for symptomatic DDD. Methods Fresh AF tissue was embedded in an optimal cutting temperature compound and cryosectioned at a thickness of 8 μm. Hematoxylin and Eosin staining was performed on sections for general histomorphological assessment. Serial sections were stained with Cy3-conjugated CHP and the mean fluorescence intensity and areal fraction of Cy3-positive staining were averaged for three regions of interest (ROI) on each CHP-stained section. Results Increases in mean fluorescence intensity (p = 0.0004) and percentage of positively stained area (p = 0.00008) with CHP were detected in DDD samples compared to the non-DDD samples. Significant correlations were observed between mean fluorescence intensity and percentage of positively stained area for both non-DDD (R = 0.98, p = 5E-8) and DDD (R = 0.79, p = 0.0012) samples. No significant differences were detected between sex and the lumbar disc level subgroups of the non-DDD and DDD groups. Only tissue pathology (non-DDD versus DDD) influenced the measured parameters. No three-way interactions between tissue pathology, sex, and lumbar disc level were observed. Discussion and Conclusions These findings suggest that AF collagen degradation is greater in DDD samples compared to non-DDD samples, as evidenced by the increased CHP staining. Strong positive correlations between the two measured parameters suggest that when collagen degradation occurs, it is detected by this technique and is widespread throughout the tissue. This study provides new insights into the structural alterations associated with collagen degradation in the AF that occur during DDD.
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Affiliation(s)
- Manmeet S. Dhiman
- Department of Biomedical EngineeringUniversity of CalgaryCalgaryAlbertaCanada
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Taylor J. Bader
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Medical SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Dragana Ponjevic
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of Veterinary MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Paul T. Salo
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Surgery, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - David A. Hart
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Surgery, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Ganesh Swamy
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Surgery, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - John R. Matyas
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of Veterinary MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Neil A. Duncan
- McCaig Institute for Bone and Joint HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Civil EngineeringUniversity of CalgaryCalgaryAlbertaCanada
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6
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Schmidt H, Shirazi-Adl A, Kingma I. 4th International workshop on spinal loading and deformation. J Biomech 2024; 174:112234. [PMID: 39054163 DOI: 10.1016/j.jbiomech.2024.112234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Hendrik Schmidt
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Aboulfazl Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering Polytechnique Montréal, Quebec, Canada
| | - Idsart Kingma
- Research Institute MOVE, Department of Human Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
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McNaughton DT, Roseen EJ, Patel S, Downie A, Øverås CK, Nim C, Harsted S, Jenkins H, Young JJ, Hartvigsen J, Wong JJ, Stone KL, Ensrud KE, Lee S, Cawthon PM, Fink HA. Long-term Trajectories of Low Back Pain in Older Men: A Prospective Cohort Study With 10-Year Analysis of the Osteoporotic Fractures in Men Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae175. [PMID: 38995164 PMCID: PMC11333921 DOI: 10.1093/gerona/glae175] [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: 03/21/2024] [Indexed: 07/13/2024] Open
Abstract
Although low back pain (LBP) may persist or recur over time, few studies have evaluated the individual course of LBP over a long-term period, particularly among older adults. Based on data from the longitudinal Osteoporotic Fractures in Men (MrOS) Study, we aimed to identify and describe different LBP trajectories in older men and characterize members in each trajectory group. A total of 5 976 community-dwelling men (mean age = 74.2) enrolled at 6 U.S. sites were analyzed. Participants self-reported LBP (yes/no) every 4 months for a maximum of 10 years. Latent class growth modeling was performed to identify unique LBP trajectory groups that explained variation in the LBP data. The association of baseline characteristics with trajectory group membership was assessed using univariable and multivariable multinominal logistic regression. A 5-class solution was chosen; no/rare LBP (n = 2 442/40.9%), low frequency-stable LBP (n = 1 040/17.4%), low frequency-increasing LBP (n = 719/12%), moderate frequency-decreasing LBP (n = 745/12.5%), and high frequency-stable LBP (n = 1 030/17.2%). History of falls (OR = 1.52), history of LBP (OR = 6.37), higher physical impairment (OR = 1.51-2.85), and worse psychological function (OR = 1.41-1.62) at baseline were all associated with worse LBP trajectory groups in this sample of older men. These findings present an opportunity for targeted interventions and/or management to older men with worse or increasing LBP trajectories and associated modifiable risk factors to reduce the impact of LBP and improve quality of life.
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Affiliation(s)
- David T McNaughton
- College of Health Sciences, School of Medical, Health, and Applied Sciences, Central Queensland University, Brisbane, Queensland, Australia
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Eric J Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedision School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Sheena Patel
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - Cecilie K Øverås
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Casper Nim
- Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Steen Harsted
- Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Hazel Jenkins
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - James J Young
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Soomi Lee
- Department of Human Development and Family Studies, Center for Healthy Aging, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Howard A Fink
- Division of Epidemiology and Community Health, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Toulou C, Chaudhari VS, Bose S. Extrusion 3D-printed tricalcium phosphate-polycaprolactone biocomposites for quercetin-KCl delivery in bone tissue engineering. J Biomed Mater Res A 2024; 112:1472-1483. [PMID: 38477071 PMCID: PMC11239310 DOI: 10.1002/jbm.a.37692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024]
Abstract
Critical-sized bone defects pose a significant challenge in advanced healthcare due to limited bone tissue regenerative capacity. The complex interplay of numerous overlapping variables hinders the development of multifunctional biocomposites. Phytochemicals show promise in promoting bone growth, but their dose-dependent nature and physicochemical properties halt clinical use. To develop a comprehensive solution, a 3D-printed (3DP) extrusion-based tricalcium phosphate-polycaprolactone (TCP-PCL) scaffold is augmented with quercetin and potassium chloride (KCl). This composite material demonstrates a compressive strength of 30 MPa showing promising stability for low load-bearing applications. Quercetin release from the scaffold follows a biphasic pattern that persists for up to 28 days, driven via diffusion-mediated kinetics. The incorporation of KCl allows for tunable degradation rates of scaffolds and prevents the initial rapid release. Functionalization of scaffolds facilitates the attachment and proliferation of human fetal osteoblasts (hfOB), resulting in a 2.1-fold increase in cell viability. Treated scaffolds exhibit a 3-fold reduction in osteosarcoma (MG-63) cell viability as compared to untreated substrates. Ruptured cell morphology and decreased mitochondrial membrane potential indicate the antitumorigenic potential. Scaffolds loaded with quercetin and quercetin-KCl (Q-KCl) demonstrate 76% and 89% reduction in bacterial colonies of Staphylococcus aureus, respectively. This study provides valuable insights as a promising strategy for bone tissue engineering (BTE) in orthopedic repair.
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Affiliation(s)
- Connor Toulou
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, Washington, USA
| | - Vishal Sharad Chaudhari
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, Washington, USA
| | - Susmita Bose
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, Washington, USA
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Hancock M, Kongsted A. Towards improving the Global Burden of Disease estimates for low back pain. THE LANCET. RHEUMATOLOGY 2024; 6:e588-e589. [PMID: 39029485 DOI: 10.1016/s2665-9913(24)00182-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/21/2024]
Affiliation(s)
- Mark Hancock
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia.
| | - Alice Kongsted
- Depatment of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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10
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Reneman MF, Coenen P, Kuijer PPFM, van Dieën JH, Holtemann A, Igwesi-Chidobe CN, Parker R, Reezigt R, Stochkendahl MJ, Hoegh M. Tensions of Low-Back Pain and Lifting; Bridging Clinical Low-Back Pain and Occupational Lifting Guidelines. JOURNAL OF OCCUPATIONAL REHABILITATION 2024; 34:473-480. [PMID: 38842652 DOI: 10.1007/s10926-024-10210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Affiliation(s)
- Michiel F Reneman
- Department of Rehabilitation / Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Societal Participation and Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Musculoskeletal Health, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Department of Public and Occupational Health, Netherlands Center for Occupational Diseases, People and Work Outpatient Clinic, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Andreas Holtemann
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Chinonso Nwamaka Igwesi-Chidobe
- School of Allied Health Professions and Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK
- Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
| | - Romy Parker
- Pain Unit, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Roland Reezigt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences-Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Physiotherapy, Academy of Health, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Mette J Stochkendahl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Morten Hoegh
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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11
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Xu H, Wang Z, Wang Z, Lei Y, Chen J, Zhou H, Li M, Diao J, Bian Y, Zhou B, Zhou Y. Recent trends in Tuina for chronic pain management: A bibliometric analysis and literature review. Complement Ther Med 2024; 84:103068. [PMID: 39004289 DOI: 10.1016/j.ctim.2024.103068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND The utilization of Tuina as a therapeutic intervention for the management of chronic pain has experienced a gradually increase in its popularity, and the purpose of this bibliometric analysis is to offer a comprehensive understanding of the current state and frontier trends, as well as to provide recommendations for future research directions. METHODS Publications on Tuina for chronic pain published between 2004 and 2023 were retrieved from the Web of Science Core Collection (WoSCC). Microsoft Excel, CiteSpace, VOSViewer, and the R package "bibliometrix" were used to quantitatively analyse the annual publication volume, countries/regions, journals, institutions, cited references, authors, and keywords. RESULTS A total of 287 publications were retrieved. The number of annual publications on the use of Tuina for treating chronic pain has gradually increased. Most publications were published in China and the United States. Notably, the most productive institution and author were identified as Shanghai University of Traditional Chinese Medicine and Min Fang, respectively. Medicine ranked first as the most influential affiliate and most productive journal. These publications came from 1650 authors, among whom Edzard Ernst had the most co-citations. Keyword analysis revealed that the new research frontier was low back pain. CONCLUSION The utilization of Tuina for the treatment of chronic pain has been gaining increasing recognition. Acupuncture, randomised controlled trials, systematic reviews, etc. were the main research subjects. Furthermore, low back pain is the new research frontier. This study provides an in-depth perspective on Tuina for chronic pain, which provides valuable reference material for clinicians with insights of therapeutic strategy, educators with valuable topics, and researchers with new research directions.
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Affiliation(s)
- Hui Xu
- Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Zheng Wang
- Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Zhen Wang
- Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Yang Lei
- Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Juntao Chen
- Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Hang Zhou
- Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Mengmeng Li
- Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Jieyao Diao
- Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Yanqin Bian
- Orthopedic Research Laboratory, University of California, Davis 95616, USA
| | - Bin Zhou
- Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China; Tuina Department, Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China.
| | - Yunfeng Zhou
- Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China.
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12
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Wu Y, Wulf Hanson S, Culbreth G, Purcell C, Brooks P, Kopec J, March L, Woolf AD, Pasovic M, Hamilton E, Santomauro D, Vos T. Assessing the impact of health-care access on the severity of low back pain by country: a case study within the GBD framework. THE LANCET. RHEUMATOLOGY 2024; 6:e598-e606. [PMID: 39029487 PMCID: PMC11333387 DOI: 10.1016/s2665-9913(24)00151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is key for policy making. Low back pain is the leading cause of disability in terms of years lived with disability (YLDs). Due to sparse data, a current limitation of GDB is that a uniform severity distribution is presumed based on 12-Item Short Form Health Survey scores derived from US Medical Expenditure Panel Surveys (MEPS). We present a novel approach to estimate the effect of exposure to health interventions on the severity of low back pain by country and over time. METHODS We extracted treatment effects for ten low back pain interventions from the Cochrane Database, combining these with coverage data from the MEPS to estimate the hypothetical severity in the absence of treatment in the USA. Severity across countries was then graded using the Health Access and Quality Index, allowing estimates of averted and avoidable burden under various treatment scenarios. FINDINGS We included 210 trials from 36 Cochrane systematic reviews in the network analysis. The pooled effect sizes (measured as a standardised mean difference) for the most effective intervention classes were -0·460 (95% uncertainty interval -0·606 to -0·309) for a combination of psychological and physical interventions and -0·366 (-0·525 to -0·207) for surgery. Globally, access to treatment averted an estimated 17·6% (14·8 to 23·8) of the low back pain burden in 2020. If all countries had provided access to treatment at a level estimated for Iceland with the highest Health Access and Quality Index score, an extra 9·1% (6·4 to 11·2) of the burden of low back pain could be avoided. Even with full coverage of optimal treatment, a large proportion (65·9% [56·9 to 70·4]) of the low back pain burden is unavoidable. INTERPRETATION This methodology fills an important shortcoming in the GBD by accounting for low back pain severity variations over time and between countries. Assumptions of unequal treatment access increased YLD estimates in resource-poor settings, with a modest decrease in countries with higher Health Access and Quality Index scores. Nonetheless, the large proportion of unavoidable burden indicates poor intervention efficacy. This method, applicable to other GBD conditions, provides policy makers with insights into health gains from improved treatment and underscores the importance of investing in research for new interventions. FUNDING Bill and Melinda Gates Foundation and Queensland Health.
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Affiliation(s)
- YiFan Wu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Sarah Wulf Hanson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Garland Culbreth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Caroline Purcell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peter Brooks
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, VIC, Australia; College of Health and Medicine, University of Tasmania, Hobart, TAS Australia
| | - Jacek Kopec
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Lyn March
- Rheumatology and Musculosketal Epidemiology Medicine, Northern Clinical School, Sydney, NSW, Australia
| | | | - Maja Pasovic
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Damian Santomauro
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Queensland Centre for Mental Health Research, Wacol, QLD, Australia; School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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13
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Tang Y, Zhuo D, Yu Y, Pu W, Ma Y, Zhang Y, Huang Y, Zhang Q, Tang K, Meng C, Yang D, Bai L, He D, Jin L, Zou H, Xu H, Zhu Q, Wang J, Chen Y, Liu J. Single-cell RNA sequencing reveals the CRTAC1 + population actively contributes to the pathogenesis of spinal ligament degeneration by SPP1 + macrophage. Aging Cell 2024:e14320. [PMID: 39158018 DOI: 10.1111/acel.14320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/12/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024] Open
Abstract
Degenerative spinal stenosis is a chronic disease that affects the spinal ligaments and associated bones, resulting in back pain and disorders of the limbs among the elderly population. There are few preventive strategies for such ligament degeneration. We here aimed to establish a comprehensive transcriptomic atlas of ligament tissues to identify high-priority targets for pharmaceutical treatment of ligament degeneration. Here, single-cell RNA sequencing was performed on six degenerative ligaments and three traumatic ligaments to understand tissue heterogeneity. After stringent quality control, high-quality data were obtained from 32,014 cells. Distinct cell clusters comprising stromal and immune cells were identified in ligament tissues. Among them, we noted that collagen degradation associated with CTHRC1+ fibroblast-like cells and calcification linked to CRTAC1+ chondrocyte-like cells were key features of ligament degeneration. SCENIC analysis and further experiments identified ATF3 as a key transcription factor regulating the pathogenesis of CRTAC1+ chondrocyte-like cells. Typically, immune cells infiltrate localized organs, causing tissue damage. In our study, myeloid cells were found to be inflammatory-activated, and SPP1+ macrophages were notably enriched in degenerative ligaments. Further exploration via CellChat analysis demonstrated a robust interaction between SPP1+ macrophages and CRTAC1+ chondrocyte-like cells. Activated by SPP1, ATF3 propels the CRTAC1/MGP/CLU axis, fostering ligament calcification. Our unique resource provides novel insights into possible mechanisms underlying ligament degeneration, the target cell types, and molecules that are expected to mitigate degenerative spinal ligament. We also highlight the role of immune regulation in ligament degeneration and calcification, enhancing our understanding of this disease.
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Affiliation(s)
- Yulong Tang
- Shanghai Key Laboratory of Vascular Lesions and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, and Human Phenome Institute, Zhangjiang Fudan International Innovation Center, Fudan University, Shanghai, China
- State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
| | - Dachun Zhuo
- Shanghai Key Laboratory of Vascular Lesions and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, and Human Phenome Institute, Zhangjiang Fudan International Innovation Center, Fudan University, Shanghai, China
| | - Yuexin Yu
- Shanghai Key Laboratory of Vascular Lesions and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, and Human Phenome Institute, Zhangjiang Fudan International Innovation Center, Fudan University, Shanghai, China
| | - Weilin Pu
- State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
- Greater Bay Area Institute of Precision Medicine (Guangzhou), School of Life Sciences, Fudan University, Guangzhou, China
| | - Yanyun Ma
- Ministry of Education Key Laboratory of Contemporary Anthropology, Department of Anthropology and Human Genetics, School of Life Sciences, Fudan University, Shanghai, China
- Research Unit of Dissecting the Population Genetics and Developing New Technologies for Treatment and Prevention of Skin Phenotypes and Dermatological Diseases (2019RU058), Chinese Academy of Medical Sciences, Beijing, China
| | - Yuting Zhang
- State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
| | - Yan Huang
- State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
| | - Qing Zhang
- State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
| | - Kunhai Tang
- State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
| | - Chen Meng
- Shanghai Key Laboratory of Vascular Lesions and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, and Human Phenome Institute, Zhangjiang Fudan International Innovation Center, Fudan University, Shanghai, China
| | - Di Yang
- Shanghai Key Laboratory of Vascular Lesions and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, and Human Phenome Institute, Zhangjiang Fudan International Innovation Center, Fudan University, Shanghai, China
| | - Lu Bai
- Shanghai Key Laboratory of Vascular Lesions and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, and Human Phenome Institute, Zhangjiang Fudan International Innovation Center, Fudan University, Shanghai, China
| | - Dongyi He
- Institute of Arthritis Research, Shanghai Academy of Chinese Medical Sciences, Guanghua Integrative Medicine Hospital, Shanghai, China
- Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Li Jin
- State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
- Research Unit of Dissecting the Population Genetics and Developing New Technologies for Treatment and Prevention of Skin Phenotypes and Dermatological Diseases (2019RU058), Chinese Academy of Medical Sciences, Beijing, China
| | - Hejian Zou
- Division of Rheumatology, Huashan Hospital, and Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
| | - Huji Xu
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Qi Zhu
- Institute of Arthritis Research, Shanghai Academy of Chinese Medical Sciences, Guanghua Integrative Medicine Hospital, Shanghai, China
- Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Jiucun Wang
- State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
- Research Unit of Dissecting the Population Genetics and Developing New Technologies for Treatment and Prevention of Skin Phenotypes and Dermatological Diseases (2019RU058), Chinese Academy of Medical Sciences, Beijing, China
- Division of Rheumatology, Huashan Hospital, and Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
| | - Yuanyuan Chen
- Orthopedic Department, Shanghai Sixth People's Hospital, Shanghai Jiaotong University Affiliated, Shanghai, China
- Orthopaedic Department, People's Hospital of Shigatse City, Shigatse, China
| | - Jing Liu
- Shanghai Key Laboratory of Vascular Lesions and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, and Human Phenome Institute, Zhangjiang Fudan International Innovation Center, Fudan University, Shanghai, China
- State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
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14
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Arora NK, Donath L, Owen PJ, Miller CT, Kaczorowski S, Saueressig T, Pedder H, Mundell NL, Tagliaferri SD, Diwan A, Chen X, Zhao X, Huessler EM, Ehrenbrusthoff K, Ford JJ, Hahne AJ, Hammel L, Norda H, Belavy DL. DOSage of Exercise for chronic low back pain disorders (DOSE): protocol for a systematic review with dose-response network meta-analysis. BMJ Open Sport Exerc Med 2024; 10:e002108. [PMID: 39161554 PMCID: PMC11331831 DOI: 10.1136/bmjsem-2024-002108] [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] [Accepted: 07/05/2024] [Indexed: 08/21/2024] Open
Abstract
Chronic low back disorders are the leading cause of direct and indirect healthcare burden globally. Exercise training improves pain intensity, mental health and physical function. However, the optimal prescription variables are unknown. We aim to compare the efficacy of various exercise dosages for chronic low back disorders to identify the optimal prescription variables. Six databases (Medline, SPORTDiscus, CINAHL, PsycINFO, EMBASE and CENTRAL), trial registries (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) and reference lists of prior systematic reviews will be searched, and we will conduct forward and backward citation tracking. We will include peer-reviewed randomised controlled trials (individual, cluster or cross-over trials) published in English or German language comparing exercise training to other exercise training or non-exercise training interventions (conservative, non-surgical, non-pharmacological, non-invasive treatments, placebo, sham, usual/standard care, no-treatment control, waitlist control) in adults with chronic low back disorders. Outcomes will include pain intensity, disability, mental health, adverse events, adherence rate, dropout rate and work capacity. Version 2 of the Cochrane risk-of-bias tool will be employed. The dose will be categorised as cumulative dose (total and weekly minutes of exercise training) and individual dose prescription variables (intervention duration, session duration, frequency and intensity). Dose-response model-based network meta-analysis will be used to assess the comparative efficacy of different exercise doses to determine a dose-response relationship. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation. Information about optimal exercise training dosage will help in enhancing treatment outcomes.
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Affiliation(s)
- Nitin Kumar Arora
- Hochschule für Gesundheit, Department of Applied Health Sciences, Division of Physiotherapy, University of Applied Sciences, Bochum, Germany
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Koln, Germany
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Koln, Germany
| | - Patrick J Owen
- Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Svenja Kaczorowski
- Hochschule für Gesundheit, Department of Applied Health Sciences, Division of Physiotherapy, University of Applied Sciences, Bochum, Germany
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Koln, Germany
| | | | - Hugo Pedder
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Niamh L Mundell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Scott D Tagliaferri
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen Ltd, Parkville, Victoria, Australia
| | - Ashish Diwan
- St. George Hospital, Department of Orthopaedic Surgery, Spine Service, University of New South Wales, Sydney, New South Wales, Australia
| | - Xiaolong Chen
- St. George Hospital, Department of Orthopaedic Surgery, Spine Service, University of New South Wales, Sydney, New South Wales, Australia
| | - Xiaohui Zhao
- Xi’an University of Architecture & Technology, Beilin, China
| | - Eva-Maria Huessler
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
| | - Katja Ehrenbrusthoff
- Hochschule für Gesundheit, Department of Applied Health Sciences, Division of Physiotherapy, University of Applied Sciences, Bochum, Germany
| | - Jon J Ford
- Discipline of Physiotherapy, School of Allied Health, Human Services & Sport, La Trobe University, Bundoora, Victoria, Australia
- Advance Healthcare, Victoria, Victoria, Australia
| | - Andrew J. Hahne
- Discipline of Physiotherapy, School of Allied Health, Human Services & Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Ludwig Hammel
- Deutsche Vereinigung Morbus Bechterew e.V. (DVMB), 97421 Schweinfurt, Germany
| | - Heike Norda
- UVSD SchmerzLOS e.V. (Unabhängige Vereinigung aktiver Schmerzpatienten in Deutschland), 24534 Neumünster, Germany
| | - Daniel L Belavy
- Hochschule für Gesundheit, Department of Applied Health Sciences, Division of Physiotherapy, University of Applied Sciences, Bochum, Germany
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15
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Martin SC, Baranidharan G, Thomson S, Gulve A, Manfield JH, Mehta V, Love-Jones S, Strachan R, Bojanić S, Eldabe S, FitzGerald JJ. Spinal Cord Stimulation Improves Quality of Life for Patients With Chronic Pain-Data From the UK and Ireland National Neuromodulation Registry. Neuromodulation 2024:S1094-7159(24)00646-9. [PMID: 39152988 DOI: 10.1016/j.neurom.2024.06.501] [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: 03/30/2024] [Revised: 06/11/2024] [Accepted: 06/28/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Spinal cord stimulation (SCS) is a well-established treatment for chronic pain and is supported by numerous studies. However, some recent articles have questioned its efficacy. This article examines a cohort of >1800 patients with SCS from the UK and Ireland National Neuromodulation Registry. It is intended to provide a "real-world" assessment of efficacy and compare its effects with other procedures performed for painful indications. MATERIALS AND METHODS Quality of life (QoL) data (EuroQoL five-level [EQ5D]) and demographic data were extracted from the National Neuromodulation Registry for all patients (N = 1811) who underwent SCS for chronic pain in 27 centers in the UK between February 2018 and July 2022. These were compared with data from the published literature for other commonly performed elective surgical procedures. RESULTS The EQ5D utility index increased by a mean of 0.202 in the 1236 patients with paired pre- and postoperative utility scores. The median utility was 0.263 (interquartile range [IQR] = 0.384; n = 1811) preoperatively, whereas at six months after the operation, it was 0.550 (IQR = 0.396; n = 1025), p < 0.0001, Wilcoxon rank sum test. The median utility score at 12 months postoperation was 0.548 (IQR = 0.417; n = 970). There was no difference in utility scores at six months and 12 months after implantation (p = 0.15, Wilcoxon rank sum test). There was a significant improvement in QoL in all five domains of the five-level EQ5D tool at six months after baseline (p < 0.01, for all subcategories), and this was sustained at one year after implantation. The baseline utility was lower than in patients who underwent elective surgery for other painful conditions, and the absolute (and proportionate) increase in utility produced by SCS was greater than that achieved with most other interventions. CONCLUSIONS SCS increases the QoL in patients requiring surgery for pain. Similar results were seen regardless of SCS indication. When comparing analogous data bases, SCS produces a greater percentage improvement in EQ5D utility than do many other elective surgical procedures for painful conditions, including spinal surgery and some joint replacements.
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Affiliation(s)
- Sean C Martin
- Neuromodulation Society of UK and Ireland; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Ganesan Baranidharan
- Neuromodulation Society of UK and Ireland; Leeds Neuromodulation Centre, Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Simon Thomson
- Neuromodulation Society of UK and Ireland; Department of Pain Medicine and Neuromodulation, Mid & South Essex University Hospitals National Health Service Foundation Trust, Essex, UK
| | - Ashish Gulve
- Neuromodulation Society of UK and Ireland; Department of Pain Medicine, James Cook University Hospital, Middlesbrough, UK
| | - James H Manfield
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
| | - Vivek Mehta
- Neuromodulation Society of UK and Ireland; Department of Pain Medicine and Neuromodulation, St Bartholomew's Hospital, London, UK
| | - Sarah Love-Jones
- Neuromodulation Society of UK and Ireland; The Pain Clinic, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Roger Strachan
- Neuromodulation Society of UK and Ireland; Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - Stana Bojanić
- Neuromodulation Society of UK and Ireland; Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Sam Eldabe
- Neuromodulation Society of UK and Ireland; Department of Pain Medicine, James Cook University Hospital, Middlesbrough, UK
| | - James J FitzGerald
- Neuromodulation Society of UK and Ireland; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK.
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16
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Chen C, Du Y, Cao K, You Y, Pi L, Jiang D, Yang M, Wu X, Chen M, Zhou W, Qi J, Chen D, Yan R, Zhu C, Yang S. Global years lived with disability for musculoskeletal disorders in adults 70 Years and older from 1990 to 2019, and projections to 2040. Heliyon 2024; 10:e35026. [PMID: 39166013 PMCID: PMC11333889 DOI: 10.1016/j.heliyon.2024.e35026] [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: 02/08/2024] [Revised: 07/13/2024] [Accepted: 07/22/2024] [Indexed: 08/22/2024] Open
Abstract
In this article, we provided a comprehensive overview and in-depth analysis of global patterns and temporal trends in years lived with disability (YLDs) for musculoskeletal (MSK) disorders in individuals aged ≥70. Data on YLDs for MSK disorders in individuals aged ≥70 were obtained from the Global Burden of Disease 2019. The average annual percentage change (AAPC) was calculated to assess the temporal trends in the YLDs rate of MSK disorders. A Bayesian Age-Period-Cohort model was used to predict the YLDs rate up to the year 2040. In 2019, the global rate of YLDs for MSK disorders in individuals aged ≥70 were 4819.81 (95 % UI: 3402.91 - 6550.77) per 100,000 persons. The YLDs rate of MSK disorders in female was 1.36 times higher than that in male, and was highest in high SDI regions. From 1990 to 2019, the global YLDs rate showed a slightly downward trend (AAPC = -0.04 %, 95 % CI: -0.06 % to -0.03 %), while it significantly increased in high, low-middle, low SDI regions. Tobacco and high body mass index were the primary risk factors worldwide, while in low SDI regions, occupational risks emerged as the predominant factors. Up to 2040, the global YLDs rate of MSK disorders are expected to increase by 1.78 %, with 36.39 %, 20.66 %, 18.96 % and 5.32 % growth in other MSK disorders, rheumatoid arthritis, neck pain and osteoarthritis. MSK disorders are a significant and continuously growing public health concern among older adults. Tailored interventions should be developed for older adults, taking into account the variations across distributions, trends, and risk factors in terms of sex and SDI levels.
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Affiliation(s)
- Can Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxia Du
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Kexin Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yue You
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Lucheng Pi
- Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Daixi Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengya Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyue Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengsha Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenkai Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaxing Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Dingmo Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Rui Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Changtai Zhu
- Department of Transfusion Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shigui Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Department of Emergency Medicine, Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
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Chen ZF, Kong XM, Yang CH, Li XY, Guo H, Wang ZW. Global, regional, and national burden and trends of migraine among youths and young adults aged 15-39 years from 1990 to 2021: findings from the global burden of disease study 2021. J Headache Pain 2024; 25:131. [PMID: 39134934 PMCID: PMC11318134 DOI: 10.1186/s10194-024-01832-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 07/18/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Migraine, a widespread neurological condition, substantially affects the quality of life, particularly for adolescents and young adults. While its impact is significant, there remains a paucity of comprehensive global research on the burden of migraine in younger demographics. Our study sought to elucidate the global prevalence, incidence, and disability-adjusted life-years (DALYs) associated with migraine in the 15-39 age group from 1990 to 2021, utilizing data from the Global Burden of Disease (GBD) 2021 study. METHODS Our comprehensive study analyzed migraine data from the GBD 2021 report, examining the prevalence, incidence, and DALYs across 204 countries and territories over a 32-year span. We stratified the information by age, sex, year, geographical region, and Socio-demographic Index (SDI). To evaluate temporal trends in these metrics, we employed the estimated annual percentage change (EAPC) calculation. RESULTS Between 1990 and 2021, the worldwide prevalence of migraine among 15-39 year-olds increased substantially. By 2021, an estimated 593.8 million cases were reported, representing a 39.52% rise from 425.6 million cases in 1990. Global trends showed increases in age-standardized prevalence rate, incidence rate, and DALY rate for migraine during this period. The EAPC were positive for all three metrics: 0.09 for ASPR, 0.03 for ASIR, and 0.09 for DALY rate. Regions with medium SDI reported the highest absolute numbers of prevalent cases, incident cases, and DALYs in 2021. However, high SDI regions demonstrated the most elevated rates overall. Across the globe, migraine prevalence peaked in the 35-39 age group. Notably, female rates consistently exceeded male rates across all age categories. CONCLUSION The global impact of migraine on youths and young adults has grown considerably from 1990 to 2021, revealing notable variations across SDI regions, countries, age groups, and sexes. This escalating burden necessitates targeted interventions and public health initiatives, especially in areas and populations disproportionately affected by migraine.
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Affiliation(s)
- Zhi-Feng Chen
- Department of Anesthesiology, School of Medicine, Shanghai Putuo People's Hospital, Tongji University, Shanghai, China
| | - Xiang-Meng Kong
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Huangpu District, No.639 Zhizaoju Road, Shanghai, 200011, China
| | - Cheng-Hao Yang
- Department of Vascular Surgery, School of Medicine, Shanghai Putuo People's Hospital, Tongji University, Shanghai, China
| | - Xin-Yu Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, PR China.
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
| | - Hong Guo
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Zhao-Wei Wang
- Department of Neurology, Qianjiang Central Hospital of Hubei Province, Hubei, China.
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Wildenbeest MH, Prins MR, Vos LA, Kiers H, Tuijt M, van Dieën JH. Precision of trunk movement in people with chronic low back pain. Musculoskelet Sci Pract 2024; 73:103165. [PMID: 39163708 DOI: 10.1016/j.msksp.2024.103165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/22/2024] [Accepted: 08/11/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND Motor control exercise is commonly applied in people with chronic low back pain (CLBP), but possibly not all people with CLBP have motor control impairments. We suggest movement precision as measure to identify motor control impairments. Movement precision has been operationalized as trunk movement variability (TMV) and as trunk tracking error(s) (TTE). OBJECTIVES To compare the known-group validity and the responsiveness of TMV and TTE. DESIGN We used a case-control comparison (Healthy controls (n = 30) vs CLBP (n = 60)) to assess the known-group validity. A cohort study, (measurements in week 3 and week 12 of treatment), was used to assess responsiveness. METHODS TMV (temporal (CyclSD) and spatial (MeanSD)) was analyzed during standing, repetitive flexion and rotation tasks (35x). TTE was measured during movement target tracking tasks, again in flexion and rotation. Participants with CLBP followed a multidisciplinary intervention and both measures were assessed in week 3 and week 12 of treatment. 2-way MANOVA and 2-way ANOVA were used to assess the effect of Group (CLBP vs healthy controls) and direction (flexion vs rotation) on TMV and TTE. For responsiveness, 2-way MANOVA and 2-way ANOVA were used to assess the effect of treatment and direction on both measures. FINDINGS At baseline, TMV was not different between groups, while TTE was higher in the people with CLBP (p = 0.005, np2 = 0.09). Treatment strongly decreased temporal TMV (p = 0.025, np2 = 0.33) and TTE (p < 0.001, np2 = 0.844). CONCLUSIONS These results demonstrate that TTE is more sensitive to CLBP and more responsive to treatment than TMV.
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Affiliation(s)
- Meta H Wildenbeest
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, 3501 AA, Utrecht, the Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT, Amsterdam, the Netherlands.
| | - Maarten R Prins
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, 3501 AA, Utrecht, the Netherlands; Research and Development, Military Rehabilitation Centre 'Aardenburg', Doorn, the Netherlands
| | - Lammert A Vos
- Research and Development, Military Rehabilitation Centre 'Aardenburg', Doorn, the Netherlands
| | - Henri Kiers
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, 3501 AA, Utrecht, the Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT, Amsterdam, the Netherlands
| | - Matthijs Tuijt
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, 3501 AA, Utrecht, the Netherlands; Department of Movement, Research Group on Human Movement, Health and Wellbeing, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT, Amsterdam, the Netherlands
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Feller D, Wingbermuhle R, Berg B, Vigdal ØN, Innocenti T, Grotle M, Ostelo R, Chiarotto A. Improvements Are Needed in the Adherence to the TRIPOD Statement for Clinical Prediction Models for Patients With Spinal Pain or Osteoarthritis: A Metaresearch Study. THE JOURNAL OF PAIN 2024:104624. [PMID: 39002741 DOI: 10.1016/j.jpain.2024.104624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024]
Abstract
This metaresearch study aimed to evaluate the completeness of reporting of prediction model studies in patients with spinal pain or osteoarthritis (OA) in terms of adherence to the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) statement. We searched for prognostic and diagnostic prediction models in patients with spinal pain or OA in MEDLINE, Embase, Web of Science, and CINAHL. Using a standardized assessment form, we assessed the adherence to the TRIPOD of the included studies. Two independent reviewers performed the study selection and data extraction phases. We included 66 studies. Approximately 35% of the studies declared to have used the TRIPOD. The median adherence to the TRIPOD was 59% overall (interquartile range (IQR): 21.8), with the items of the methods and results sections having the worst reporting. Studies on neck pain had better adherence to the TRIPOD than studies on back pain and OA (medians of 76.5%, 59%, and 53%, respectively). External validation studies had the highest total adherence (median: 79.5%, IQR: 12.8) of all the study types. The median overall adherence was 4 points higher in studies that declared TRIPOD use than those that did not. Finally, we did not observe any improvement in adherence over the years. The adherence to the TRIPOD of prediction models in the spinal and OA fields is low, with the methods and results sections being the most poorly reported. Future studies on prediction models in spinal pain and OA should follow the TRIPOD to improve their reporting completeness. PERSPECTIVE: This article provides data about adherence to the TRIPOD statement in 66 prediction model studies for spinal pain or OA. The adherence to the TRIPOD statement was found to be low (median adherence of 59%). This inadequate reporting may negatively impact the effective use of the models in clinical practice.
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Affiliation(s)
- Daniel Feller
- Department of Rehabilitation, Provincial Agency for Health of the Autonomous Province of Trento, Trento, Italy; Department of Human Resources, Provincial Agency for Health of the Autonomous Province of Trento, Trento, Italy; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Roel Wingbermuhle
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Physiotherapy and Rehabilitation sciences, SOMT University of Physiotherapy, Amersfoort, the Netherlands
| | - Bjørnar Berg
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ørjan Nesse Vigdal
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; GIMBE Foundation, Bologna, Italy
| | - Margreth Grotle
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit & Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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20
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Bing T, Shanlin X, Jisheng W, Jie H, Ruichao C, Zhiwei Z, Bin Y, Zhaoxin M, Zhenming H, Nian Z. Dysregulated lipid metabolism and intervertebral disc degeneration: the important role of ox-LDL/LOX-1 in endplate chondrocyte senescence and calcification. Mol Med 2024; 30:117. [PMID: 39123116 PMCID: PMC11311918 DOI: 10.1186/s10020-024-00887-8] [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: 04/28/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Lipid metabolism disorders are associated with degeneration of multiple tissues and organs, but the mechanism of crosstalk between lipid metabolism disorder and intervertebral disc degeneration (IDD) has not been fully elucidated. In this study we aim to investigate the regulatory mechanism of abnormal signal of lipid metabolism disorder on intervertebral disc endplate chondrocyte (EPC) senescence and calcification. METHODS Human intervertebral disc cartilage endplate tissue, cell model and rat hyperlipemia model were performed in this study. Histology and immunohistochemistry were used to human EPC tissue detection. TMT-labelled quantitative proteomics was used to detect differential proteins, and MRI, micro-CT, safranin green staining and immunofluorescence were performed to observe the morphology and degeneration of rat tail intervertebral discs. Flow cytometry, senescence-associated β-galactosidase staining, alizarin red staining, alkaline phosphatase staining, DCFH-DA fluorescent probe, and western blot were performed to detect the expression of EPC cell senescence, senescence-associated secretory phenotype, calcification-related proteins and the activation of cell senescence-related signaling pathways. RESULTS Our study found that the highly expressed oxidized low-density lipoprotein (ox-LDL) and Lectin-like oxidized low-density lipoprotein receptor 1 (LOX-1) in human degenerative EPC was associated with hyperlipidemia (HLP). TMT-labelled quantitative proteomics revealed enriched pathways such as cell cycle regulation, endochondral bone morphogenesis and inflammation. The rat model revealed that HLP could induce ox-LDL, LOX-1, senescence and calcification markers high expression in EPC. Moreover, we demonstrated that ox-LDL-induced EPCs senescence and calcification were dependent on the LOX-1 receptor, and the ROS/P38-MAPK/NF-κB signaling pathway was implicated in the regulation of senescence induced by ox-LDL/LOX-1 in cell model. CONCLUSIONS So our study revealed that ox-LDL/LOX-1-induced EPCs senescence and calcification through ROS/P38-MAPK/NF-κB signaling pathway, providing information on understanding the link between lipid metabolism disorders and IDD.
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Affiliation(s)
- Tan Bing
- Department of Spine Surgery, The Third Hospital of Mian Yang, Sichuan Mental Health Center, 621000, Mianyang, People's Republic of China
- Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 400000, Chongqing, People's Republic of China
| | - Xiang Shanlin
- Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 400000, Chongqing, People's Republic of China
| | - Wang Jisheng
- Department of Pharmacy, The Third Hospital of Mian Yang, Sichuan Mental Health Center, 621000, Mianyang, People's Republic of China
| | - Hao Jie
- Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 400000, Chongqing, People's Republic of China
| | - Cao Ruichao
- Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 400000, Chongqing, People's Republic of China
| | - Zhang Zhiwei
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 400000, Chongqing, People's Republic of China
| | - Yu Bin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 400000, Chongqing, People's Republic of China
| | - Ma Zhaoxin
- Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 400000, Chongqing, People's Republic of China
| | - Hu Zhenming
- Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 400000, Chongqing, People's Republic of China
| | - Zhou Nian
- Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 400000, Chongqing, People's Republic of China.
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21
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El Chamaa A, Kowalski K, Parikh P, Rushton A. Patients' experiences with musculoskeletal spinal pain: A qualitative systematic review protocol. PLoS One 2024; 19:e0306993. [PMID: 39116059 PMCID: PMC11309383 DOI: 10.1371/journal.pone.0306993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/25/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Musculoskeletal (MSK) spinal pain encapsulates various conditions including lumbar (low back), cervical (neck), and thoracic pain that significantly impact individual and global health. While clinical aspects of spinal pain have been well-studied, understanding patients' personal narratives and lived experiences remains essential for enhancing patient-centered care, improving treatment adherence, and informing healthcare policies. It provides deep insights into the impacts of spinal pain, guiding more effective and empathetic treatment approaches. This systematic review aims to synthesize qualitative evidence on patients' experiences with MSK spinal pain, providing insight into the challenges faced, coping strategies, daily life impacts, and healthcare interactions. The objective of this review is to synthesize the qualitative evidence regarding the lived experiences of patients with MSK spinal pain. METHODS This systematic review will use a meta-aggregation approach to synthesize data from qualitative studies, that will be identified through a comprehensive search of electronic databases and supplemented by grey literature searches. Two independent reviewers will screen, identify, and extract data from eligible studies. In cases of disagreement, conflicts will be resolved by consulting a third reviewer. These same reviewers will then use the Joanna Briggs Institute (JBI) qualitative quality assessment tool to evaluate the methodological quality of the identified studies, with the derived scores informing the synthesis process, that will involve extracting each study's findings along with their supporting illustrations, then grouped into categories based on similarity in meaning. These categories will then be aggregated to form synthesized findings. IMPLICATIONS Synthesized findings on patients' lived experiences with MSK spinal pain including key themes, patterns, and insights will be presented. By emphasizing patient narratives, the results of the review can contribute to the optimization of outcomes, and to enhance patient-provider relations and improve quality of care in MSK spinal health.
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Affiliation(s)
- Alaa El Chamaa
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Katie Kowalski
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Pulak Parikh
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Alison Rushton
- Faculty of Health Sciences, Western University, London, Ontario, Canada
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22
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Ciaffi J, Papalexis N, Vanni E, Miceli M, Faldini C, Scotti L, Zambon A, Salvarani C, Caporali R, Facchini G, Ursini F. Minimally invasive interventional procedures for osteoarthritis and inflammatory arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2024; 68:152525. [PMID: 39137511 DOI: 10.1016/j.semarthrit.2024.152525] [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: 03/03/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE to summarize the evidence on the efficacy of minimally invasive interventional procedures such as radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) in patients with osteoarthritis or inflammatory arthritis. METHODS a literature search was conducted in PubMed and Web of Science databases. Both randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSI) were included. The results were organized according to the treated anatomical site: knee, hip, foot and ankle, shoulder, hand and wrist, sacroiliac joints. Data about treatment efficacy were extracted. The main outcome was change in pain intensity using the 0-10 visual analog scale (VAS) from baseline to 1 month. Additional timepoints at 3, 6 and 12 months were assessed. Change in functional status was evaluated. Pooled estimates were calculated as the mean difference (MD) and 95 % confidence interval relative to baseline. The meta-analyses of RCTs and NRSI were conducted separately. RESULTS of the 4599 retrieved articles, 164 were included in the review and, considering all the established timepoints, 111 (38 RCTs and 73 NRSI) were selected for the meta-analysis. Only one article described patients with inflammatory arthritis. In the meta-analysis of RCTs, one month after the procedure, MD in VAS was -3.98 (-4.41 to -3.55; k = 21) for knee RFA, and -3.18 (-3.96 to -2.39; k = 8) for sacroiliac joints RFA. In the meta-analysis of NRSI, MD in VAS was -4.12 (-4.63 to -3.61; k = 23) for knee RFA, -3.84 (-4.77 to -2.92; k = 7) for knee TAE, -4.34 (-4.96 to -3.71; k = 2) for hip RFA, -3.83 (-4.52 to -3.15; k = 3) for shoulder RFA and -4.93 (-5.58 to -4.28; k = 14) for sacroiliac joints RFA. Significant decrease in pain intensity was found also at 3, 6 and 12 months. Additionally, functional status improved at all the assessed timepoints. CONCLUSION minimally invasive interventional procedures can improve pain and functional status of patients affected by OA or chronic sacroiliac pain of degenerative origin. Further research is warranted in the field of inflammatory rheumatic diseases.
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Affiliation(s)
- Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | - Nicolas Papalexis
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elena Vanni
- Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia and Università di Modena e Reggio Emilia, Modena, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carlo Salvarani
- Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia and Università di Modena e Reggio Emilia, Modena, Italy
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan and ASST G. Pini-CTO, Milan, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Ziade N, Udod M, Kougkas N, Tsiami S, Baraliakos X. Significant overlap of inflammatory and degenerative features on imaging among patients with degenerative disc disease, diffuse idiopathic skeletal hyperostosis and axial spondyloarthritis: a real-life cohort study. Arthritis Res Ther 2024; 26:147. [PMID: 39097721 PMCID: PMC11297750 DOI: 10.1186/s13075-024-03359-w] [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: 04/13/2024] [Accepted: 06/30/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Differentiating between degenerative disc disease (DDD), diffuse idiopathic skeletal hyperostosis (DISH), and axial spondyloarthritis (axSpA) represents a diagnostic challenge in patients with low back pain (LBP). We aimed to evaluate the distribution of inflammatory and degenerative imaging features in a real-life cohort of LBP patients referred to a tertiary university rheumatology center. METHODS In a retrospective cross-sectional analysis of patients referred for LBP, demographics, symptom information, and available imaging were collected. SpA-like changes were considered in the spine in the presence of one of the following lesions typically related to SpA: erosions, sclerosis, squaring, and syndesmophytes on conventional radiographs (CR) and bone marrow oedema (BMO), erosions, sclerosis, and fat lesions (FL) on MRI. SIJ CR were graded per New York criteria; on MRIs, SIJs were evaluated by quadrant for BMO, erosions, FL, sclerosis and ankylosis, similar to the approach used by the Berlin SIJ MRI scoring system. The final diagnosis made by the rheumatologist was the gold standard. Data were presented descriptively, by patient and by quadrant, and compared among the three diagnosis groups. RESULTS Among 136 referred patients, 71 had DDD, 38 DISH, and 27 axSpA; median age 62 years [IQR55-73], 63% males. On CR, SpA-like changes were significantly higher in axSpA in the lumbar (50%, vs. DDD 23%, DISH 22%), in DISH in the thoracic (28%, vs. DDD 8%, axSpA 12%), and in DDD in the cervical spine (67% vs. DISH 0%, axSpA 33%). On MRI, BMO was significantly higher in DISH in the thoracic (37%, vs. DDD 22%, axSpA 5%) and equally distributed in the lumbar spine (35-42%). FL were significantly more frequently identified in DISH and axSpA in the thoracic (56% and 52%) and DDD and axSpA in the lumbar spine (65% and 74%, respectively). Degenerative changes were frequent in the three groups. Sacroiliitis (NY criteria) was identified in 49% (axSpA 76%, DDD 48%, DISH 29%). CONCLUSION A significant overlap was found among DDD, DISH, and axSpA for inflammatory and degenerative imaging features. Particularly, SpA-like spine CR features were found in one-fourth of patients with DISH, and MRI BMO was found in one-third of those patients.
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Affiliation(s)
- Nelly Ziade
- Hotel-Dieu De France, Saint Joseph University, Beirut, Lebanon
| | - Melanie Udod
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstr. 45, 44649, Herne, Germany
| | - Nikolaos Kougkas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Styliani Tsiami
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstr. 45, 44649, Herne, Germany
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstr. 45, 44649, Herne, Germany.
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24
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Hansen JL, Wangen KR. Trajectories of opioid use among patients with low back pain: Association to work absence. Eur J Pain 2024. [PMID: 39092517 DOI: 10.1002/ejp.4706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Low back pain (LBP) is a leading reason for opioid use and a closer examination of opioid use and productivity losses among these patients is needed. We identify opioid use trajectories using a group-based trajectory model (GBTM) and estimate productivity losses across the trajectories. METHODS Patients diagnosed with LBP in Swedish specialty care between 2011 and 2015, between the ages of 20 and 60, were included. Two GBTMs were estimated on monthly opioid use (converted to oral morphine equivalents) during the two 12-month periods preceding and following diagnosis. Productivity losses were estimated using the human-capital approach. RESULTS In total, 147,035 patients were included. The mean age at diagnosis was 43 years of age and 49% of the patients were male. A qualitative assessment of the identified groups in the GBTM models was made based on the patterns of opioid use. We chose three pre-diagnosis groups characterized as 'Pre-low' (N = 109,492), 'Pre-increase' (N = 27,336) and 'Pre-high' (N = 10,207). Similarly, four post-diagnosis groups were chosen and characterized as 'Post-low' (N = 73,287), 'Post-decrease' (N = 39,446), 'Post-moderate' (N = 20,001) and 'Post-high' (N = 13,595). Only 50% of the patients in the 'Pre-high' group were in the 'Post-high' group. The total productivity losses by the pre-diagnosis groups were more than 2.7 billion Euros over the total 6-year study period. CONCLUSION This study highlights how patients with LBP and high use of opioids are highly correlated before and after diagnosis. Patients with high use of opioids also exhibit high work absence and productivity losses. SIGNIFICANCE STATEMENT This was the first study to estimate trajectories of opioids in the two time periods before and after a diagnosis of low back pain. For the first time, productivity losses were also estimated across the identified opioid use trajectories.
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Corrêa LA, Mathieson S, Hancock M, Verhagen A, Nogueira LAC, Young A, Pate JW, French SD. Questionnaires assessing knowledge and beliefs about musculoskeletal conditions are potentially suitable for use, but further research is needed: a systematic review. J Clin Epidemiol 2024; 172:111398. [PMID: 38810841 DOI: 10.1016/j.jclinepi.2024.111398] [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: 01/04/2024] [Revised: 04/21/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES To evaluate the measurement properties of Patient-reported outcome measures (PROMs) for knowledge and/or beliefs about musculoskeletal conditions. STUDY DESIGN AND SETTING A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. This review was prospectively registered on PROSPERO - ID: CRD42022303111. Electronic databases, reference lists, forward citation tracking, and contact with experts were used to identify studies. Eligible studies were reports developing or assessing a measurement property of a PROM measuring musculoskeletal condition specific-knowledge and/or beliefs. We assessed the methodological quality and measurement properties of included studies. A modified Grading of Recommendations Assessment Development and Evaluation approach was used to rate the quality of evidence for each PROM. RESULTS The literature search was performed from inception to 11th September 2023. Sixty records were included, reporting 290 individual studies, and provided information on 25 PROMs. Five PROMs presented sufficient structural validity, three presented sufficient cross-cultural validity, ten presented sufficient reliability, three presented sufficient criterion validity, six presented sufficient hypothesis-testing, and four presented sufficient responsiveness. No PROM presented sufficient evidence for content validity, internal consistency, and measurement error. Based on the available evidence, no PROM was classified as suitable for use according to the COSMIN recommendations. Twenty-four PROMs are potentially suitable for use, and one PROM is not recommended for use. CONCLUSION No PROM designed to assess knowledge and/or beliefs about musculoskeletal conditions meets the COSMIN criteria of suitable for use. Most PROMs identified in this systematic review were considered as potentially suitable for use and need further high-quality research to assess their measurement properties.
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Affiliation(s)
- Leticia Amaral Corrêa
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Stephanie Mathieson
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark Hancock
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Arianne Verhagen
- University of Technology Sydney, Graduate School of Health, Physiotherapy, Ultimo, Australia
| | | | - Annie Young
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Joshua W Pate
- University of Technology Sydney, Graduate School of Health, Physiotherapy, Ultimo, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Bell EC, Heng H, Alousis N, King MG, Hahne A, Collins T, See K, Webster T, O'Dowd E, Jackson P, Semciw AI. Patient and Staff Insights on Digital Care Pathways for Patients With Low Back Pain in the Emergency Department: A Qualitative Study. Health Expect 2024; 27:e14182. [PMID: 39152538 PMCID: PMC11329376 DOI: 10.1111/hex.14182] [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: 06/06/2024] [Revised: 07/17/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Back pain is a huge global problem. For some people, the pain is so severe that they feel the need to present to an emergency department (ED). Our aim was to explore patient and staff perspectives for the development of a digital care pathway (DCP) for people with back pain who have presented to ED, including acceptability, barriers and facilitators. METHODS We used a descriptive phenomenology approach using semi-structured interviews with patient and staff participants at a tertiary hospital. Interviews were transcribed and data codes were developed using inductive thematic analysis. Themes were discussed between researchers until consensus was achieved. RESULTS A total of 16 interviews were carried out, half of which involved patient participants. We identified three major themes: (i) expectations and experiences of staff and patients with low back pain in ED; (ii) a digital care pathway can empower patients and support clinicians in providing care; and (iii) acceptability, barriers, facilitators and recommendations of engaging with a DCP to track the trajectory of back pain. Each theme was further categorised into subthemes. CONCLUSION Introducing a DCP was perceived as acceptable and beneficial by patients and staff. Both groups were aware of the potential participant burden if surveys were too long. Introducing a DCP could be a valuable adjunct to current management care models, providing a standardised source of education with the potential for individualised tracking and monitoring. The design and development of a DCP will need to consider reported facilitators and address perceived barriers for engagement. PATIENT OR PUBLIC CONTRIBUTION This project sought insights from patients and staff about a digital care pathway. This forms the first step of patient and consumer consultation before implementing a digital care pathway. All consumers were offered the opportunity to review their responses and our interpretation.
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Affiliation(s)
- Emily C. Bell
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Hazel Heng
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Nicole Alousis
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Matthew G. King
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
| | - Andrew Hahne
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
| | - Thomas Collins
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Katharine See
- Digital Health Division, Clinical Leadership, Effectiveness & OutcomesNorthern HealthEppingAustralia
| | - Tracey Webster
- Digital Health Division, Clinical Leadership, Effectiveness & OutcomesNorthern HealthEppingAustralia
| | - Elisha O'Dowd
- Digital Health Division, Clinical Leadership, Effectiveness & OutcomesNorthern HealthEppingAustralia
| | - Paul Jackson
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Adam I. Semciw
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
- Department of Allied HealthNorthern HealthEppingAustralia
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Austin RR, Jantraporn R, Schulz C, Zhang R. Navigating Online Health Information: Assessing the Quality and Readability of Dietary and Herbal Supplements for Chronic Musculoskeletal Pain. Comput Inform Nurs 2024; 42:547-554. [PMID: 38787720 DOI: 10.1097/cin.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Affiliation(s)
- Robin R Austin
- Author Affiliations: University of Minnesota, School of Nursing (Ms. Austin, Jantraporn); Integrative Health and Wellbeing Research Program, Earl E. Bakken Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN (Dr Austin and Mr Schulz); and Department of Surgery, University of Minnesota, School of Medicine (Dr Zhang)
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Sao K, Risbud MV. Sdc4 deletion perturbs intervertebral disc matrix homeostasis and promotes early osteopenia in the aging mouse spine. Matrix Biol 2024; 131:46-61. [PMID: 38806135 DOI: 10.1016/j.matbio.2024.05.006] [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: 01/10/2024] [Revised: 05/07/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
Syndecan 4 (SDC4), a cell surface heparan sulfate proteoglycan, is known to regulate matrix catabolism by nucleus pulposus cells in an inflammatory milieu. However, the role of SDC4 in the aging spine has never been explored. Here we analyzed the spinal phenotype of Sdc4 global knockout (KO) mice as a function of age. Micro-computed tomography showed that Sdc4 deletion severely reduced vertebral trabecular and cortical bone mass, and biomechanical properties of vertebrae were significantly altered in Sdc4 KO mice. These changes in vertebral bone were likely due to elevated osteoclastic activity. The histological assessment showed subtle phenotypic changes in the intervertebral disc. Imaging-Fourier transform-infrared analyses showed a reduced relative ratio of mature collagen crosslinks in young adult nucleus pulposus (NP) and annulus fibrosus (AF) of KO compared to wildtype discs. Additionally, relative chondroitin sulfate levels increased in the NP compartment of the KO mice. Transcriptomic analysis of NP tissue using CompBio, an AI-based tool showed biological themes associated with prominent dysregulation of heparan sulfate GAG degradation, mitochondria metabolism, autophagy, endoplasmic reticulum (ER)-associated misfolded protein processes and ER to Golgi protein processing. Overall, this study highlights the important role of SDC4 in fine-tuning vertebral bone homeostasis and extracellular matrix homeostasis in the mouse intervertebral disc.
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Affiliation(s)
- Kimheak Sao
- Graduate Program in Cell Biology and Regenerative Medicine, Jefferson College of Life Sciences, Thomas Jefferson University, Philadelphia, United States; Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite 501 College Bldg., Philadelphia, PA 19107, United States
| | - Makarand V Risbud
- Graduate Program in Cell Biology and Regenerative Medicine, Jefferson College of Life Sciences, Thomas Jefferson University, Philadelphia, United States; Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Suite 501 College Bldg., Philadelphia, PA 19107, United States.
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Roseen EJ, McNaughton DT, Harrison S, Downie AS, Øverås CK, Nim CG, Jenkins HJ, Young JJ, Hartvigsen J, Stone KL, Ensrud KE, Lee S, Cawthon PM, Fink HA. Association of back pain with all-cause and cause-specific mortality among older men: a cohort study. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:505-513. [PMID: 38741219 PMCID: PMC11292054 DOI: 10.1093/pm/pnae040] [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: 01/31/2024] [Revised: 03/27/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE We evaluated whether more severe back pain phenotypes-persistent, frequent, or disabling back pain-are associated with higher mortality rate among older men. METHODS In this secondary analysis of a prospective cohort, the Osteoporotic Fractures in Men (MrOS) study, we evaluated mortality rates by back pain phenotype among 5215 older community-dwelling men (mean age, 73 years, SD = 5.6) from 6 sites in the United States. The primary back pain measure used baseline and Year 5 back pain questionnaire data to characterize participants as having no back pain, nonpersistent back pain, infrequent persistent back pain, or frequent persistent back pain. Secondary measures of back pain from the Year 5 questionnaire included disabling back pain phenotypes. The main outcomes measured were all-cause and cause-specific death. RESULTS After the Year 5 exam, during up to 18 years of follow-up (mean follow-up = 10.3 years), there were 3513 deaths (1218 cardiovascular, 764 cancer, 1531 other). A higher proportion of men with frequent persistent back pain versus no back pain died (78% versus 69%; sociodemographic-adjusted HR = 1.27, 95% CI = 1.11-1.45). No association was evident after further adjustment for health-related factors, such as self-reported general health and comorbid chronic health conditions (fully adjusted HR = 1.00; 95% CI = 0.86-1.15). Results were similar for cardiovascular deaths and other deaths, but we observed no association of back pain with cancer deaths. Secondary back pain measures, including back-related disability, were associated with increased mortality risk that remained statistically significant in fully adjusted models. CONCLUSION Although frequent persistent back pain was not independently associated with risk of death in older men, additional secondary disabling back pain phenotypes were independently associated with increased mortality rate. Future investigations should evaluate whether improvements in disabling back pain affect general health and well-being or risk of death.
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Affiliation(s)
- Eric J Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, MA 02131, United States
- Department of Physical Medicine & Rehabilitation and Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA 02130, United States
| | - David T McNaughton
- School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Stephanie Harrison
- Research Institute, California Pacific Medical Center, San Francisco, CA 94107, United States
| | - Aron S Downie
- Department of Chiropractic, Macquarie University, Sydney, 2109, Australia
| | - Cecilie K Øverås
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, 7034, Norway
| | - Casper G Nim
- Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, 5000, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, 5000, Denmark
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5000, Denmark
| | - Hazel J Jenkins
- Department of Chiropractic, Macquarie University, Sydney, 2109, Australia
| | - James J Young
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5000, Denmark
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, M5T 0S8, Canada
| | - Jan Hartvigsen
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, M5T 0S8, Canada
- The Chiropractic Knowledge Hub, University of Southern Denmark, Odense, 5000, Denmark
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA 94107, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94158, United States
| | - Kristine E Ensrud
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55415, United States
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN 55417, United States
| | - Soomi Lee
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802, United States
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA 94107, United States
| | - Howard A Fink
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55415, United States
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN 55417, United States
- Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN 55417, United States
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Petersen KKS. The interaction between psychological factors and conditioned pain modulation. Br J Pain 2024; 18:312-313. [PMID: 39092210 PMCID: PMC11289904 DOI: 10.1177/20494637241263306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Affiliation(s)
- Kristian Kjær-Staal Petersen
- Department of Materials and Production, Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Center for Neuroplasticity and Pain, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Gottlieb M, Bernard K. Epidemiology of back pain visits and medication usage among United States emergency departments from 2016 to 2023. Am J Emerg Med 2024; 82:125-129. [PMID: 38905718 DOI: 10.1016/j.ajem.2024.06.020] [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: 05/20/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024] Open
Abstract
INTRODUCTION Low back pain is a common reason for presentation to the Emergency Department (ED). However, there are limited large-scale, recent data on the epidemiology, disposition, and medication administration for this condition. The objective of this was to assess the incidence, admission rates, medication administrations, and discharge prescriptions among ED visits for low back pain in the United States. METHODS This was a cross-sectional study of ED presentations for low back pain from 1/1/2016 to 12/31/2023 using the Epic Cosmos database. All ED visits for adults with low back pain identified by ICD-10 codes were included. Outcomes included admission rates, distribution of opioid, benzodiazepine, (non-benzodiazepine) muscle relaxant, acetaminophen, NSAID, and corticosteroid medications administered in the ED, and distribution of opioid, benzodiazepine, muscle relaxant, and corticosteroid medications given upon discharge. Subgroup analyses were performed by specific medication. RESULTS Of 207,154,419 ED encounters, 12,241,240 (5.9%) were due to back pain with 1,957,299 of these (16.0%) admitted. The admission rate increased over time from 12.8% to 17.1%. The most common medication given in the ED was opioids (40.7%), followed by acetaminophen (37.8%), NSAIDs (22.6%), muscle relaxants (18.4%) benzodiazepines (12.8%), and corticosteroids (5.5%). The most common medications prescribed upon discharge were muscle relaxants (32.1%), followed by opioids (23.2%), corticosteroids (12.2%), and benzodiazepines (3.0%). CONCLUSION Low back pain represents a common reason for presentation to the ED, and admissions have been increasing over time. Opioids remain the most common ED medication, whereas muscle relaxants have arisen as the most common discharge prescription. These findings can help inform health policy decisions, resource allocation, and evidence-based interventions for medication administration.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Kyle Bernard
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
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Skaar TC, Myers RA, Fillingim RB, Callaghan JT, Cicali E, Eadon MT, Elwood EN, Ginsburg GS, Lynch S, Nguyen KA, Obeng AO, Park H, Pratt VM, Rosenman M, Sadeghpour A, Shuman S, Singh R, Tillman EM, Volpi S, Wiisanen K, Winterstein AG, Horowitz CR, Voora D, Orlando L, Chakraborty H, Van Driest S, Peterson JF, Cavallari LA, Johnson JA, Dexter PR. Implementing a pragmatic clinical trial to tailor opioids for chronic pain on behalf of the IGNITE ADOPT PGx investigators. Clin Transl Sci 2024; 17:e70005. [PMID: 39177194 PMCID: PMC11342225 DOI: 10.1111/cts.70005] [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: 04/29/2024] [Revised: 07/15/2024] [Accepted: 08/04/2024] [Indexed: 08/24/2024] Open
Abstract
Chronic pain is a prevalent condition with enormous economic burden. Opioids such as tramadol, codeine, and hydrocodone are commonly used to treat chronic pain; these drugs are activated to more potent opioid receptor agonists by the hepatic CYP2D6 enzyme. Results from clinical studies and mechanistic understandings suggest that CYP2D6-guided therapy will improve pain control and reduce adverse drug events. However, CYP2D6 is rarely used in clinical practice due in part to the demand for additional clinical trial evidence. Thus, we designed the ADOPT-PGx (A Depression and Opioid Pragmatic Trial in Pharmacogenetics) chronic pain study, a multicenter, pragmatic, randomized controlled clinical trial, to assess the effect of CYP2D6 testing on pain management. The study enrolled 1048 participants who are taking or being considered for treatment with CYP2D6-impacted opioids for their chronic pain. Participants were randomized to receive immediate or delayed (by 6 months) genotyping of CYP2D6 with clinical decision support (CDS). CDS encouraged the providers to follow the CYP2D6-guided trial recommendations. The primary study outcome is the 3-month absolute change in the composite pain intensity score assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) measures. Follow-up will be completed in July 2024. Herein, we describe the design of this trial along with challenges encountered during enrollment.
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Affiliation(s)
- Todd C. Skaar
- Division of Clinical PharmacologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Rachel A. Myers
- Department of Medicine, Clinical Research UnitDuke University School of Medicine, Duke UniversityDurhamNorth CarolinaUSA
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral ScienceUniversity of Florida College of DentistryGainesvilleFloridaUSA
| | - John T. Callaghan
- Division of Clinical PharmacologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Emily Cicali
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision MedicineCollege of Pharmacy, University of FloridaGainesvilleFloridaUSA
| | - Michael T. Eadon
- Division of Clinical PharmacologyIndiana University School of MedicineIndianapolisIndianaUSA
- Division of NephrologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Erica N. Elwood
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision MedicineCollege of Pharmacy, University of FloridaGainesvilleFloridaUSA
| | | | - Sheryl Lynch
- Division of Clinical PharmacologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Khoa A. Nguyen
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision MedicineCollege of Pharmacy, University of FloridaGainesvilleFloridaUSA
| | - Aniwaa Owusu Obeng
- Pharmacy DepartmentMount Sinai Health SystemNew YorkNew YorkUSA
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Medicine, Division of General Internal MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and PolicyCollege of Pharmacy, University of FloridaGainesvilleFloridaUSA
- Center for Drug Evaluation and SafetyUniversity of FloridaGainesvilleFloridaUSA
| | - Victoria M. Pratt
- Department of Medical & Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Marc Rosenman
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
- Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern UniversityChicagoIllinoisUSA
| | - Azita Sadeghpour
- Duke Precision Medicine Program, Department of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | | | - Rajbir Singh
- Department of MedicineMeharry Medical CollegeNashvilleTennesseeUSA
| | - Emma M. Tillman
- Division of Clinical PharmacologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Simona Volpi
- Division of Genomic MedicineNational Human Genome Research InstituteBethesdaMarylandUSA
| | - Kristin Wiisanen
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision MedicineCollege of Pharmacy, University of FloridaGainesvilleFloridaUSA
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and PolicyCollege of Pharmacy, University of FloridaGainesvilleFloridaUSA
- Center for Drug Evaluation and SafetyUniversity of FloridaGainesvilleFloridaUSA
| | - Carol R. Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
| | - Deepak Voora
- Duke Precision Medicine Program, Department of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Lori Orlando
- Duke Precision Medicine Program, Department of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | | | - Sara Van Driest
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
- Present address:
All of Us Research Program, Office of the DirectorNational Institutes of HealthBethesdaMarylandUSA
| | - Josh F. Peterson
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Larisa A. Cavallari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision MedicineCollege of Pharmacy, University of FloridaGainesvilleFloridaUSA
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision MedicineCollege of Pharmacy, University of FloridaGainesvilleFloridaUSA
- Present address:
Center for Clinical and Translational ScienceColleges of Medicine and Pharmacy, The Ohio State UniversityColumbusOhioUSA
| | - Paul R. Dexter
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Regenstrief Institute, Inc.IndianapolisIndianaUSA
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Köhli P, Schönnagel L, Hambrecht J, Zhu J, Chiapparelli E, Güven AE, Evangelisti G, Amoroso K, Duculan R, Michalski B, Shue J, Tsuchiya K, Burkhard MD, Sama AA, Girardi FP, Cammisa FP, Mancuso CA, Hughes AP. The relationship between paraspinal muscle atrophy and degenerative lumbar spondylolisthesis at the L4/5 level. Spine J 2024; 24:1396-1406. [PMID: 38570036 DOI: 10.1016/j.spinee.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/CONTEXT Degenerative lumbar spondylolisthesis (DLS) is a prevalent spinal condition that can result in significant disability. DLS is thought to result from a combination of disc and facet joint degeneration, as well as various biological, biomechanical, and behavioral factors. One hypothesis is the progressive degeneration of segmental stabilizers, notably the paraspinal muscles, contributes to a vicious cycle of increasing slippage. PURPOSE To examine the correlation between paraspinal muscle status on MRI and severity of slippage in patients with symptomatic DLS. STUDY DESIGN/SETTING Retrospective cross-sectional study at an academic tertiary care center. PATIENT SAMPLE Patients who underwent surgery for DLS at the L4/5 level between 2016-2018 were included. Those with multilevel DLS or insufficient imaging were excluded. OUTCOME MEASURES The percentage of relative slippage (RS) at the L4/5 level evaluated on standing lateral radiographs. Muscle morphology measurements including functional cross-sectional area (fCSA), body height normalized functional cross-sectional area (HI) of Psoas, erector spinae (ES) and multifidus muscle (MF) and fatty infiltration (FI) of ES and MF were measured on axial MR. Disc degeneration and facet joint arthritis were classified according to Pfirrmann and Weishaupt, respectively. METHODS Descriptive and comparative statistics, univariable and multivariable linear regression models were utilized to examine the associations between RS and muscle parameters, adjusting for confounders sex, age, BMI, segmental degeneration, and back pain severity and symptom duration. RESULTS The study analyzed 138 out of 183 patients screened for eligibility. The median age of all patients was 69.5 years (IQR 62 to 73), average BMI was 29.1 (SD±5.1) and average preoperative ODI was 46.4 (SD±16.3). Patients with Meyerding-Grade 2 (M2, N=25) exhibited higher Pfirrmann scores, lower MFfCSA and MFHI, and lower BMI, but significantly more fatty infiltration in the MF and ES muscles compared to those with Meyerding Grade 1 (M1). Univariable linear regression showed that each cm2 decrease in MFfCSA was associated with a 0.9%-point increase in RS (95% CI -1.4 to - 0.4, p<.001), and each cm2/m2 decrease in MFHI was associated with an increase in slippage by 2.2%-points (95% CI -3.7 to -0.7, p=.004). Each 1%-point rise in ESFI and MFFI corresponded to 0.17%- (95% CI 0.05-0.3, p=.01) and 0.20%-point (95% CI 0.1-0.3 p<.001) increases in relative slippage, respectively. Notably, after adjusting for confounders, each cm2 increase in PsoasfCSA and cm2/m2 in PsoasHI was associated with an increase in relative slippage by 0.3% (95% CI 0.1-0.6, p=.004) and 1.1%-points (95% CI 0.4-1.7, p=.001). While MFfCSA tended to be negatively associated with slippage, this did not reach statistical significance (p=.105). However, each 1%-point increase in MFFI and ESFI corresponded to increases of 0.15% points (95% CI 0.05-0.24, p=.002) and 0.14% points (95% CI 0.01-0.27, p=.03) in relative slippage, respectively. CONCLUSION This study found a significant association between paraspinal muscle status and severity of slippage in DLS. Whereas higher degeneration of the ES and MF correlate with a higher degree of slippage, the opposite was found for the psoas. These findings suggest that progressive muscular imbalance between posterior and anterior paraspinal muscles could contribute to the progression of slippage in DLS.
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Affiliation(s)
- Paul Köhli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Charitéplatz 1, Berlin 10117, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, Charitéplatz 1, Berlin 10117, Germany
| | - Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Charitéplatz 1, Berlin 10117, Germany
| | - Jan Hambrecht
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA; Department of Trauma Surgery, University Hospital Zurich, Ramistrasse 100, Zurich 8091, Switzerland
| | - Jiaqi Zhu
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71th Street, New York, NY 10021, USA
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Ali E Güven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Gisberto Evangelisti
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA; Instituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, Bologna, BO, 40136, Italy
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | | | - Bernhard Michalski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Charitéplatz 1, Berlin 10117, Germany
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Koki Tsuchiya
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA; Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Marco D Burkhard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA
| | - Carol A Mancuso
- Hospital for Special Surgery, New York City, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, 525 East 71st Street, New York City, NY 10021, USA.
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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.
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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
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Moyo P, Merlin JS, Gairola R, Girard A, Shireman TI, Trivedi AN, Marshall BDL. Association of Opioid Use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrospective Cohort Analysis. J Gen Intern Med 2024; 39:2097-2105. [PMID: 38829451 PMCID: PMC11306843 DOI: 10.1007/s11606-024-08799-3] [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: 11/22/2023] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Practice guidelines recommend nonpharmacologic and nonopioid therapies as first-line pain treatment for acute pain. However, little is known about their utilization generally and among individuals with opioid use disorder (OUD) for whom opioid and other pharmacologic therapies carry greater risk of harm. OBJECTIVE To determine the association between a pre-existing OUD diagnosis and treatment of acute low back pain (aLBP). DESIGN Retrospective cohort study using 2016-2019 Medicare data. PARTICIPANTS Fee-for-service Medicare beneficiaries with a new episode of aLBP. MAIN MEASURES The main independent variable was OUD diagnosis measured prior to the first LBP claim (i.e., index date). Using multivariable logistic regressions, we assessed the following outcomes measured within 30 days of the index date: (1) nonpharmacologic therapies (physical therapy and/or chiropractic care), and (2) prescription opioids. Among opioid recipients, we further assessed opioid dose and co-prescription of gabapentin. Analyses were conducted overall and stratified by receipt of physical therapy, chiropractic care, opioid fills, or gabapentin fills during the 6 months before the index date. KEY RESULTS We identified 1,263,188 beneficiaries with aLBP, of whom 3.0% had OUD. Two-thirds (65.8%) did not receive pain treatments of interest at baseline. Overall, nonpharmacologic therapy receipt was less prevalent and opioid and nonopioid pharmacologic therapies were more common among beneficiaries with OUD than those without OUD. Beneficiaries with OUD had lower odds of receiving nonpharmacologic therapies (aOR = 0.62, 99%CI = 0.58-0.65) and higher odds of prescription opioid receipt (aOR = 2.24, 99%CI = 2.17-2.32). OUD also was significantly associated with increased odds of opioid doses ≥ 90 morphine milligram equivalents/day (aOR = 2.43, 99%CI = 2.30-2.56) and co-prescription of gabapentin (aOR = 1.15, 99%CI = 1.09-1.22). Similar associations were observed in stratified groups though magnitudes differed. CONCLUSIONS Medicare beneficiaries with aLBP and OUD underutilized nonpharmacologic pain therapies and commonly received opioids at high doses and with gabapentin. Complementing the promulgation of practice guidelines with implementation science could improve the uptake of evidence-based nonpharmacologic therapies for aLBP.
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Affiliation(s)
- Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Jessica S Merlin
- Division of General Internal Medicine, Challenges in Managing and Preventing Pain Clinical Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richa Gairola
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Anthony Girard
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Theresa I Shireman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Amal N Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Cao Z, Han K, Lu H, Illangamudalige S, Shaheed CA, Chen L, McLachlan AJ, Patanwala AE, Maher CG, Lin CWC, March L, Ferreira ML, Mathieson S. Paracetamol Combination Therapy for Back Pain and Osteoarthritis: A Systematic Review and Meta-Analyses. Drugs 2024; 84:953-967. [PMID: 38937394 PMCID: PMC11343817 DOI: 10.1007/s40265-024-02065-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND AND OBJECTIVE Although paracetamol (acetaminophen) combined with other analgesics can reduce pain intensity in some pain conditions, its effectiveness in managing low back pain and osteoarthritis is unclear. This systematic review investigated whether paracetamol combination therapy is more effective and safer than monotherapy or placebo in low back pain and osteoarthritis. METHODS Online database searches were conducted for randomised trials that evaluated paracetamol combined with another analgesic compared to a placebo or the non-paracetamol ingredient in the combination (monotherapy) in low back pain and osteoarthritis. The primary outcome was a change in pain. Secondary outcomes were (serious) adverse events, changes in disability and quality of life. Follow-up was immediate (≤ 2 weeks), short (> 2 weeks but ≤ 3 months), intermediate (> 3 months but < 12 months) or long term (≥ 12 months). A random-effects meta-analysis was conducted. Risk of bias was assessed using the original Cochrane tool, and quality of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Twenty-two studies were included. Pain was reduced with oral paracetamol plus a non-steroidal anti-inflammatory drug (NSAID) at immediate term in low back pain (paracetamol plus ibuprofen vs ibuprofen [mean difference (MD) - 6.2, 95% confidence interval (CI) -10.4 to -2.0, moderate evidence]) and in osteoarthritis (paracetamol plus aceclofenac vs aceclofenac [MD - 4.7, 95% CI - 8.3 to - 1.2, moderate certainty evidence] and paracetamol plus etodolac vs etodolac [MD - 15.1, 95% CI - 18.5 to - 11.8; moderate certainty evidence]). Paracetamol plus oral tramadol reduced pain compared with placebo at intermediate term for low back pain (MD - 11.7, 95% CI - 19.2 to - 4.3; very low certainty evidence) and osteoarthritis (MD - 6.8, 95% CI - 12.7 to -0.9; moderate certainty evidence). Disability scores improved in half the comparisons. Quality of life was infrequently measured. All paracetamol plus NSAID combinations did not increase the risk of adverse events compared to NSAID monotherapy. CONCLUSIONS Low-to-moderate quality evidence supports the oral use of some paracetamol plus NSAID combinations for short-term pain relief with no increased risk of harm for low back pain and osteoarthritis compared to its non-paracetamol monotherapy comparator.
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Affiliation(s)
- Zhiying Cao
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kaiyue Han
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Hanting Lu
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Christina Abdel Shaheed
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
| | - Lingxiao Chen
- Department of Orthopedics, Shandong University Centre for Orthopedics, Advanced Medical Research Institute, Qilu Hospital of Shandong University, Shandong University, Jinan, China
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Andrew J McLachlan
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
| | - Asad E Patanwala
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
- Department of Pharmacy, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
| | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
| | - Lyn March
- Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Manuela L Ferreira
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie Mathieson
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia.
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Núñez-Cortés R, Salazar-Méndez J, Calatayud J, Lluch E, López-Bueno R, Horment-Lara G, Cruz-Montecinos C, Suso-Martí L. How do the target concepts of pain science education combined with exercise contribute to the effect on pain intensity and disability in patients with chronic spinal pain? A systematic review and meta-analysis with moderator analysis. Neurosci Biobehav Rev 2024; 163:105740. [PMID: 38852291 DOI: 10.1016/j.neubiorev.2024.105740] [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: 03/20/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024]
Abstract
The aim of this study was to assess the moderator effect of the target concepts covered in the Pain science education (PSE) sessions, including both the total amount of target concepts and each individual target concept, on changes in pain intensity and disability in patients with chronic spinal pain (CSP). A systematic search of PubMed, Scopus, Embase, Web of Science and CENTRAL was conducted from inception to March 10, 2024. A random effects model was used for meta-regression analysis. A total of 11 studies were included. The total amount of target concepts of PSE showed a significant correlation with changes in pain intensity (k=11; F=4.45; p=0.04; R2=26.07 %). In terms of each target content, only a significant effect on pain intensity was obtained for 'transfer knowledge about pain to an adaptive behavioural change' (z=-2.35, P =0.019, 95 %CI -3.42 to -0.31) and 'reconceptualization of pain' (z=-2.43, P =0.015, 95 %CI -3.70 to -0.39). No significant effect on disability was found. These results may be useful for optimising the effectiveness of PSE programmes.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380286, Chile; Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia 46010, Spain
| | - Joaquín Salazar-Méndez
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca 3460000, Chile
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia 46010, Spain; National Research Centre for the Working Environment, Copenhagen 2100, Denmark
| | - Enrique Lluch
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia 46010, Spain; Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia 46010, Spain; National Research Centre for the Working Environment, Copenhagen 2100, Denmark; Department of Physical Medicine and Nursing, University of Zaragoza, Spain
| | - Giselle Horment-Lara
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380286, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380286, Chile; Section of Research, Innovation and Development in kinesiology, Kinesiology Unit, San José Hospital, Santiago 8380286, Chile.
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia 46010, Spain
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Duarte C, Santos R, Fernandes O, Raimundo A. Prevalence of Lower Back Pain in Portuguese Equestrian Riders. Sports (Basel) 2024; 12:207. [PMID: 39195583 DOI: 10.3390/sports12080207] [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: 06/07/2024] [Revised: 07/26/2024] [Accepted: 07/27/2024] [Indexed: 08/29/2024] Open
Abstract
Lower back pain is prevalent in equestrian athletes, but its prevalence and associated factors are unknown in the Portuguese equestrian population. A questionnaire regarding lower back pain and possible associated factors was answered by 347 respondents. Of the respondents, 214 (61.7%) stated having experienced lower back pain in the past 12 months and therefore completed the Roland Morris disability questionnaire. Among the latter, 63.1% stated that lower back pain impaired their performance. The probability of suffering from lower back pain was higher in individuals with higher weekly riding workloads, who reported equestrianism as their main occupation, and who performed daily stable duties. Considering a Roland Morris disability score of 4 as the cut-off value for dysfunction, this sample had an average score of 5.39 ± 4.42. Individuals who stated equestrianism was their main occupation showed a significantly higher risk (OR = 1.759, p = 0.041) of exhibiting a score ≥ 4 than those who stated equestrianism as a hobby. Age (p = 0.029), body mass index (p = 0.047), and daily performance of stable duties (p = 0.030) were also associated with a higher Roland Morris disability score. Further research is needed to understand the full impacts of lower back pain in Portuguese equestrian athletes.
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Affiliation(s)
- Carlota Duarte
- Escola Superior de Biociências de Elvas, Instituto Politécnico de Portalegre, 7300-110 Portalegre, Portugal
| | - Rute Santos
- Escola Superior de Biociências de Elvas, Instituto Politécnico de Portalegre, 7300-110 Portalegre, Portugal
- VALORIZA-Research Centre for Endogenous Resource Valorization, Instituto Politécnico de Portalegre, 7300-555 Portalegre, Portugal
| | - Orlando Fernandes
- Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
- CHRC-Comprehensive Health Research Centre, Universidade de Évora, 7004-516 Évora, Portugal
| | - Armando Raimundo
- Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
- CHRC-Comprehensive Health Research Centre, Universidade de Évora, 7004-516 Évora, Portugal
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Mirpuri P, Khalid S, Colliander R, King P, Tao X, Elsamadicy A, Mehta AI, Adogwa O. The Impact of Preoperative Spinal Injection Timing on the Postoperative Complications of Lumbar Fusion. World Neurosurg 2024:S1878-8750(24)01190-2. [PMID: 39002778 DOI: 10.1016/j.wneu.2024.07.050] [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: 06/30/2024] [Accepted: 07/05/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE To determine the impact of epidural spinal injections (ESIs) on postoperative surgical complications. METHODS This retrospective all-payer database analysis identified 202,181 adult patients undergoing one- to three-level transforaminal lumbar interbody fusion (TLIF) from 2010 to 2020. A 1:1 exact matching on comorbidities and demographics was performed, creating 2 cohorts: 1) patients who received an ESI within 90 days of surgery and 2) patients who did not receive an ESI. The primary outcome was surgical complication rates between groups at 30 days postoperatively. For the secondary outcome, patients were stratified based on injection time before surgery: 1-30, 31-45, 46-60, 61-75, and 76-90 days. Logistic regression was performed between groups to identify temporal associations of complication rates. The P value was set to 0.05 for the primary analysis, and the Bonferroni correction was utilized for the secondary outcome. RESULTS Exact matching produced 12,491 pairs for analysis. Groups were well-matched on demographics, comorbidities, and fusion levels. The 30-day postoperative rates of surgical complications, hematomas, wound disruptions, or surgical site infections did not differ between groups (P > 0.05). The rate of cerebrospinal fluid (CSF) leak was increased in the ESI group (0.19% vs. 0.09%, P = 0.042). When temporally stratified, patients receiving an ESI within 30 days had significantly higher odds of CSF leak (odds ratio: 4.24, 95% confidence interval: 1.97-9.14). CONCLUSIONS Patients who receive an ESI within 30 days of transforaminal lumbar interbody fusion are at an increased risk for CSF leak. While the incidence of CSF leak remains small, it may be advisable to avoid ESIs at least 30 days before surgery for certain patients.
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Affiliation(s)
- Pranav Mirpuri
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Syed Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Reid Colliander
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Patrick King
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Xu Tao
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Aladine Elsamadicy
- Department of Neurosurgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA; Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Owoicho Adogwa
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
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De Lucia A, Perlini C, Chiarotto A, Pachera S, Pasini I, Del Piccolo L, Donisi V. eHealth-Integrated Psychosocial and Physical Interventions for Chronic Pain in Older Adults: Scoping Review. J Med Internet Res 2024; 26:e55366. [PMID: 39073865 PMCID: PMC11319891 DOI: 10.2196/55366] [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: 12/11/2023] [Revised: 03/11/2024] [Accepted: 04/30/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Chronic noncancer pain (CNCP) is highly present among older adults, affecting their physical, psychological, and social functioning. A biopsychosocial multimodal approach to CNCP management is currently extensively suggested by international clinical practice guidelines. Recently, the growing development and application of eHealth within pain management has yielded encouraging results in terms of effectiveness and feasibility; however, its use among the older population remains underexamined. OBJECTIVE The overall aim of this scoping review was to systematically map existing literature about eHealth multimodal interventions (including both physical and psychosocial components) targeting older adults with CNCP. METHODS This review adhered to the JBI methodology, a protocol was a priori registered as a preprint on the medRxiv platform, and the results were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO) were systematically searched for relevant articles. Studies were included if they reported on multimodal interventions (including both physical and psychosocial components) delivered through any eHealth modality to an older population with any type of CNCP. Two reviewers selected the studies: first by screening titles and abstracts and second by screening full-text articles. The quality of the included studies was evaluated using the Quality Assessment Tool for Studies with Diverse Designs. The results of the studies were summarized narratively. RESULTS A total of 9 studies (n=6, 67% published between 2021 and 2023) with quality rated as medium to high were included, of which 7 (78%) were randomized controlled trials (n=5, 71% were pilot and feasibility studies). All the included studies evaluated self-management interventions, most of them (n=7, 78%) specifically designed for older adults. The participants were aged between 65 and 75 years on average (mean 68.5, SD 3.5 y) and had been diagnosed with different types of CNCP (eg, osteoarthritis and chronic low back pain). Most of the included studies (5/9, 56%) involved the use of multiple eHealth modalities, with a higher use of web-based programs and video consulting. Only 1 (11%) of the 9 studies involved a virtual reality-based intervention. The evaluated interventions showed signs of effectiveness in the targeted biopsychosocial outcomes, and the participants' engagement and ratings of satisfaction were generally positive. However, several research gaps were identified and discussed. CONCLUSIONS Overall, of late, there has been a growing interest in the potential that eHealth multimodal interventions offer in terms of improving pain, physical, and psychosocial outcomes in older adults with CNCP. However, existing literature on this topic still seems scarce and highly heterogeneous, with few proper randomized controlled trials, precluding robust conclusions. Several gaps emerged in terms of the older population considered and the lack of evaluation of comorbidities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1101/2023.07.27.23293235.
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Affiliation(s)
- Annalisa De Lucia
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sara Pachera
- Fondazione Casa di Riposo S Giuseppe Nonprofit Organization of Social Utility, San Martino Buon Albergo (Verona), Italy
| | - Ilenia Pasini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Valeria Donisi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Novert P, Pelletier-Visa M, Pereira B, Lanhers C, Coudeyre E. A critical appraisal of "effects of exercise therapy on disability, mobility, and quality of life in the elderly with chronic low back pain: a systematic review and meta-analysis of randomised controlled trials". J Orthop Surg Res 2024; 19:427. [PMID: 39061047 PMCID: PMC11274749 DOI: 10.1186/s13018-024-04766-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 07/28/2024] Open
Affiliation(s)
- Pierre Novert
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire de Clermont-Ferrand, CHU Clermont-Ferrand, INRAE, UNH, Clermont- Ferrand, Clermont-Ferrand, F-63000, France.
| | - Mathilde Pelletier-Visa
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire de Clermont-Ferrand, CHU Clermont-Ferrand, INRAE, UNH, Clermont- Ferrand, Clermont-Ferrand, F-63000, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et de l'Innovation, secteur Biométrie-Economie, CHU de Clermont-Ferrand, 5 place Henri Dunant, Clermont-Ferrand, France
| | - Charlotte Lanhers
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire de Clermont-Ferrand, CHU Clermont-Ferrand, INRAE, UNH, Clermont- Ferrand, Clermont-Ferrand, F-63000, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire de Clermont-Ferrand, CHU Clermont-Ferrand, INRAE, UNH, Clermont- Ferrand, Clermont-Ferrand, F-63000, France
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Schmidt H, Shirazi-Adl A, Bashkuev M, Becker LA, Pumberger M, Duda GN, Reitmaier S. Marked differences between continuous long-term and clinical snapshot examinations: is the current standard of back pain diagnostics outdated? Front Bioeng Biotechnol 2024; 12:1411958. [PMID: 39119273 PMCID: PMC11306014 DOI: 10.3389/fbioe.2024.1411958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024] Open
Abstract
Current clinical examination of low back pain (LBP) patients primarily relies on static clinical examinations, which rarely represent the dynamic postures patients adopt during daily activities. To gain an overview on the dynamic kinematics-kinetics changes over a day, the lumbar back kinematics of asymptomatic individuals and LBP patients were measured over 24 h, and the passively resisted bending and torsional moments were estimated. 208 asymptomatic subjects (115 females) and 116 LBP patients (71 females) were analysed. Compared to static upright standing, the mean lumbar lordosis of asymptomatic subjects drops significantly by 21° during everyday life (p < 0.01). Maximum bending moments of 44.0-50.6 Nm were estimated at the L2-L3. LBP patients showed significantly lower (p < 0.01) lumbar flattening during daily life of about 16°. Maximum bending moments of 27-52 Nm were found at the L3-L4. The initial static upright lumbar lordosis was significantly lower in LBP population (by 6°) resulting in almost similar average lumbar shapes during daily activities in both groups. The torsional movements were with 2.2° greatest in L1-L2 independent of sex (p = 0.19) and LBP (p = 0.54) with moments of 6-16 Nm. The lumbar profile and associated internal moments during daily life differ substantially from those recorded during clinical examinations. LBP patients demonstrates significantly lower lordosis at the snapshot assessment and significantly lower movement variations and internal moments during daily life. Only the dynamic long-term assessments unravelled a less flexed posture in LBP population. Apparently, such a reduced dynamic flexed posture indicates a compensatory habit for pain relief.
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Affiliation(s)
- Hendrik Schmidt
- Julius Wolff Institut, Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Aboulfazl Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, École Polytechnique, Montréal, Canada
| | - Maxim Bashkuev
- Julius Wolff Institut, Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Luis Alexander Becker
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N. Duda
- Julius Wolff Institut, Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Reitmaier
- Julius Wolff Institut, Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
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43
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Augustine L, Zadro J, Maher C, Traeger AC, Jones C, West CA, Yang J, O'Keeffe M, Jenkins H, McAuley JH, Ferreira GE. Perceptions of advice for acute low back pain: a content analysis of qualitative data collected in a randomised experiment. BMJ Open 2024; 14:e079070. [PMID: 39043591 PMCID: PMC11268038 DOI: 10.1136/bmjopen-2023-079070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES To explore how people perceive three different forms of advice for acute low back pain (LBP). DESIGN Content analysis of qualitative data collected in a three-arm randomised experiment. PARTICIPANTS 2200 participants with acute LBP (ie, pain duration for ≤6 weeks) were randomly assigned to receive three types of advice: guideline advice and guideline advice with the addition of either brief pain science or ergonomics messages. PRIMARY AND SECONDARY OUTCOMES After receiving the advice, participants answered two questions: 'If your health professional gave you this advice, how would it make you feel?' and 'If your health professional gave you this advice, what treatments (if any) do you think you would need?' Two researchers coded responses using deductive content analysis. RESULTS We analysed 4400 free-text responses from 2200 participants. There were little to no differences in participants' feelings, thoughts and expectations after receiving three types of advice for acute LBP. Participants most commonly expressed feeling positive about the advice (38%-35%), reassured (23%-22%) and empowered (10%-8%). Some expressed being unhappy or being frustrated with the advice (4%-3%). Participants most commonly thought they needed no treatment apart from staying active, followed by exercise and medication. CONCLUSIONS Guideline advice with or without the addition of brief pain science or ergonomics messages generated positive feelings, reassurance or a sense of empowerment in many people with acute LBP, with no difference between types of advice. TRIAL REGISTRATION NUMBER ACTRN12623000364673.
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Affiliation(s)
- Lidiya Augustine
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joshua Zadro
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Christopher Maher
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Adrian C Traeger
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Caitlin Jones
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Courtney A West
- Institute for Musculoskeletal Health, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Jingjing Yang
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mary O'Keeffe
- National University of Ireland Galway, Galway, Ireland
| | - Hazel Jenkins
- Macquarie University, Sydney, New South Wales, Australia
| | - James H McAuley
- University of New South Wales, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Giovanni E Ferreira
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
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44
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Scaff SP, Hancock MJ, Munhoz TDS, Maher CG, Saragiotto BT. Exercises for the prevention of non-specific low back pain. Cochrane Database Syst Rev 2024; 7:CD014146. [PMID: 39041371 PMCID: PMC11264324 DOI: 10.1002/14651858.cd014146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the effects of exercise alone or exercise plus education compared with inactive control or education alone to prevent non-specific LBP.
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Affiliation(s)
- Simone Ps Scaff
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil
| | - Mark J Hancock
- Discipline of Physiotherapy, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Tatiane da Silva Munhoz
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil
| | | | - Bruno T Saragiotto
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
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45
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Oliosi E, Júlio A, Probst P, Silva L, Vilas-Boas JP, Pinheiro AR, Gamboa H. Exploring the Real-Time Variability and Complexity of Sitting Patterns in Office Workers with Non-Specific Chronic Spinal Pain and Pain-Free Individuals. SENSORS (BASEL, SWITZERLAND) 2024; 24:4750. [PMID: 39066146 PMCID: PMC11281106 DOI: 10.3390/s24144750] [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: 06/20/2024] [Revised: 07/14/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Chronic spinal pain (CSP) is a prevalent condition, and prolonged sitting at work can contribute to it. Ergonomic factors like this can cause changes in motor variability. Variability analysis is a useful method to measure changes in motor performance over time. When performing the same task multiple times, different performance patterns can be observed. This variability is intrinsic to all biological systems and is noticeable in human movement. This study aims to examine whether changes in movement variability and complexity during real-time office work are influenced by CSP. The hypothesis is that individuals with and without pain will have different responses to office work tasks. Six office workers without pain and ten with CSP participated in this study. Participant's trunk movements were recorded during work for an entire week. Linear and nonlinear measures of trunk kinematic displacement were used to assess movement variability and complexity. A mixed ANOVA was utilized to compare changes in movement variability and complexity between the two groups. The effects indicate that pain-free participants showed more complex and less predictable trunk movements with a lower degree of structure and variability when compared to the participants suffering from CSP. The differences were particularly noticeable in fine movements.
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Affiliation(s)
- Eduarda Oliosi
- Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics (LIBPhys-UNL), Faculty of Sciences and Technology, NOVA University of Lisbon, 2820-001 Caparica, Portugal; (A.J.); (P.P.); (L.S.); (H.G.)
- Research Centre in Physical Activity, Health and Leisure (CIAFEL-FADEUP), Faculty of Sport, University of Porto, 4000-000 Porto, Portugal
| | - Afonso Júlio
- Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics (LIBPhys-UNL), Faculty of Sciences and Technology, NOVA University of Lisbon, 2820-001 Caparica, Portugal; (A.J.); (P.P.); (L.S.); (H.G.)
| | - Phillip Probst
- Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics (LIBPhys-UNL), Faculty of Sciences and Technology, NOVA University of Lisbon, 2820-001 Caparica, Portugal; (A.J.); (P.P.); (L.S.); (H.G.)
| | - Luís Silva
- Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics (LIBPhys-UNL), Faculty of Sciences and Technology, NOVA University of Lisbon, 2820-001 Caparica, Portugal; (A.J.); (P.P.); (L.S.); (H.G.)
| | - João Paulo Vilas-Boas
- Centre for Research, Training, Innovation and Intervention in Sport (CIFI2D), Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sport, University of Porto, 4000-000 Porto, Portugal;
| | - Ana Rita Pinheiro
- Institute of Biomedicine (iBiMED), School of Health Sciences, University of Aveiro, 3800-000 Aveiro, Portugal;
| | - Hugo Gamboa
- Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics (LIBPhys-UNL), Faculty of Sciences and Technology, NOVA University of Lisbon, 2820-001 Caparica, Portugal; (A.J.); (P.P.); (L.S.); (H.G.)
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46
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Martins Silva GZ, de Lira MR, Garcêz LR, George SZ, Neblett R, Pezolato A, Lima TC, Chaves TC. Measurement Properties of Two Questionnaires Assessing Fear-Avoidance in Patients With Chronic Low Back Pain. Eval Health Prof 2024:1632787241264588. [PMID: 39037438 DOI: 10.1177/01632787241264588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
The Fear-Avoidance Components Scale (FACS) and the Fear of Daily Activities Questionnaire (FDAQ) assess fear-avoidance model components. However, the questionnaires are not available in Brazilian Portuguese. This study aimed to translate the original English FACS and FDAQ into Brazilian (Br) Portuguese and assess their measurement properties in patients with Chronic Low Back Pain (CLBP). One hundred thirty volunteers with CLBP participated in this study. Structural validity, internal consistency, test-retest reliability, and hypothesis testing for construct validity were analyzed. Results indicated a 2-factor solution for the FACS-Br, while the FDAQ-Br had a one-factor solution. Internal consistency showed acceptable Cronbach's alpha (alpha >.8). Suitable reliability was found for the FDAQ-Br (Intraclass Correlation Coefficient [ICC] = .98). For both FACS-Br factors, suitable reliability was found as well (ICC = .95 and .94). Hypothesis testing for construct validity confirmed more than 75% of the hypotheses proposed a priori for the FACS maladaptive pain/movement-related beliefs domain and the FDAQ-Br. In conclusion, the FACS-Br and FDAQ-Br demonstrated acceptable reliability, internal consistency, and structural validity measurement properties and their correlation (r < .50) suggests that the tools are not interchangeable measures.
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Affiliation(s)
| | | | | | | | | | | | | | - Thais Cristina Chaves
- University of São Paulo - USP, Brazil
- Federal University of São Carlos - UFSCar, Brazil
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47
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Ufondu W, Robinson CL, Hussain N, D'Souza RS, Karri J, Emerick T, Orhurhu VJ. Intradiscal Autologous Biologics for the Treatment of Chronic Discogenic Low Back Pain. Curr Pain Headache Rep 2024:10.1007/s11916-024-01294-8. [PMID: 39017984 DOI: 10.1007/s11916-024-01294-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE OF REVIEW: The purpose of this narrative review is to evaluate the efficacy of the most commonly studied intradiscal biologics used for the treatment and alleviation of chronic intractable discogenic low back pain. Additionally, it explores the therapeutic potential and durability of these novel treatment options. RECENT FINDINGS: Recently published literature highlights the therapeutic potential of intradiscal biologics, such as mesenchymal stem cells, platelet-rich plasma, and alpha-2-macroglobulin, in promoting chondrogenesis within the lumbar intervertebral discs to treat discogenic low back pain. Studies demonstrate significant improvements in pain relief, physical function, and quality of life post-treatment. A comprehensive review of the literature evaluating the efficacy of intradiscal biologics suggests some evidence supporting its efficacy in treating discogenic low back pain. However, more rigorous studies into mechanistic modulation and large-scale randomized trials as well as a more thorough understanding of adverse events will be instrumental for including these therapies into clinical practice paradigms.
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Affiliation(s)
- Wisdom Ufondu
- Department of Biology, Program in Liberal Medical Education (PLME), Brown University, Providence, RI, USA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jay Karri
- Department of Orthopedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vwaire J Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA.
- MVM Health, East Stroudsburg, PA, USA.
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48
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Labecka MK, Plandowska M, Truszczyńska-Baszak A, Rajabi R, Płaszewski M, Różańska D. An Eight-Week Randomized Controlled Trial of Active Mobilization of the Hamstrings for Non-Specific Low Back Pain and Musculoskeletal Discomfort during Prolonged Sitting among Young People: Study Protocol. J Clin Med 2024; 13:4161. [PMID: 39064200 PMCID: PMC11278042 DOI: 10.3390/jcm13144161] [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: 05/26/2024] [Revised: 07/08/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Participants will be recruited from the Faculty of Physical Education and randomly assigned to either the hamstring stretching group or the control group with education only. The primary outcome measures will be pain intensity, musculoskeletal discomfort, and functional disability. Secondary outcome measures will be satisfaction with the intervention and flexibility of the hamstring. A total of 44 participants fulfilling the inclusion criteria will complete the study. As an increase in LBP frequency is observed, it seems justified to determine effective interventions for LBP and musculoskeletal discomfort in young people. The findings of this study will provide information about the effect of an 8-week intervention involving active hamstring flexibility exercises with hip flexion mobilization on the reduction of LBP and musculoskeletal discomfort during prolonged sitting in young adults. We hope this study will add to the development of ergonomic recommendations for young people with LBP.
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Affiliation(s)
- Marta Kinga Labecka
- Faculty of Rehabilitation, Jozef Pilsudski University of Physical Education, 00-968 Warsaw, Poland;
| | - Magdalena Plandowska
- Faculty of Physical Education and Health in Biala Podlaska, Jozef Pilsudski University of Physical Education, 21-500 Biala Podlaska, Poland; (M.P.); (M.P.); (D.R.)
| | | | - Reza Rajabi
- Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran 1417614411, Iran;
| | - Maciej Płaszewski
- Faculty of Physical Education and Health in Biala Podlaska, Jozef Pilsudski University of Physical Education, 21-500 Biala Podlaska, Poland; (M.P.); (M.P.); (D.R.)
| | - Dorota Różańska
- Faculty of Physical Education and Health in Biala Podlaska, Jozef Pilsudski University of Physical Education, 21-500 Biala Podlaska, Poland; (M.P.); (M.P.); (D.R.)
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49
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Bargeri S, Basso G, Geraci I, Castellini G, Chiarotto A, Gianola S, Ostelo R, Testa M, Innocenti T. Substantial discrepancies exist between registered protocol and published manuscript in trials on exercise interventions for chronic low back pain: a metaresearch study. J Clin Epidemiol 2024; 173:111465. [PMID: 39019348 DOI: 10.1016/j.jclinepi.2024.111465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/13/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVES Reporting bias, prevalent in biomedical fields, can undermine evidence credibility. Our objective was to evaluate the proportion of discrepancies between registered protocols and published manuscripts in randomized controlled trials (RCTs) on exercise interventions for patients with chronic low back pain (CLBP). STUDY DESIGN AND SETTING We conducted a cross-sectional meta-research study, starting from the 2021 "Exercise therapy for CLBP" Cochrane Review. We selected all RCTs reporting a protocol registration on a primary register of the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) or in ClinicalTrials.gov. We extracted data from both registered protocol and published manuscript of RCTs, collecting recruitment and administrative information (eg, record dates) and details of trial characteristics (eg, outcomes, arms, statistical analysis plan details [SAPs]). Independent pairs of reviewers assessed discrepancies between registered protocol and published manuscript for the reporting of primary and secondary outcomes domains, measurement instruments, time-points, number of arms and SAPs(if attached). Outcome discrepancies were characterized as addition, omission, upgrade or downgrade. RESULTS We included 116 RCTs reporting an available protocol registration. Overall, 100 RCTs (86.2%) distinguished between primary and secondary outcomes. Of these, 39 RCTs (39.0%) reported one or more discrepancies in primary outcomes, and 78 RCTs (78.0%) reported one or more discrepancies in secondary outcomes. Focusing on discrepancies for the primary outcome, 64.5% of added, upgraded or downgraded outcomes favored statistically significant effects. Few RCTs (n = 6) reported discrepancies in the number of arms. SAPs were poorly reported in the registered protocols (n = 3) for being compared to the publications. CONCLUSION We found substantial outcome discrepancies comparing registered protocols and published manuscripts in RCTs assessing exercise interventions for patients with CLBP, with some impacting the statistical significance of the effects. Readers are encouraged to approach RCTs results in this field with caution.
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Affiliation(s)
- Silvia Bargeri
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giacomo Basso
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova, Genova, Italy
| | - Ignazio Geraci
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova, Genova, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit & Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Marco Testa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova, Genova, Italy
| | - Tiziano Innocenti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova, Genova, Italy; Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; GIMBE Foundation, Bologna, Italy.
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50
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Pocovi NC, Lin CWC, French SD, Graham PL, van Dongen JM, Latimer J, Merom D, Tiedemann A, Maher CG, Clavisi O, Tong SYK, Hancock MJ. Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. Lancet 2024; 404:134-144. [PMID: 38908392 DOI: 10.1016/s0140-6736(24)00755-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Recurrence of low back pain is common and a substantial contributor to the disease and economic burden of low back pain. Exercise is recommended to prevent recurrence, but the effectiveness and cost-effectiveness of an accessible and low-cost intervention, such as walking, is yet to be established. We aimed to investigate the clinical effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention to prevent the recurrence of low back pain. METHODS WalkBack was a two-armed, randomised controlled trial, which recruited adults (aged 18 years or older) from across Australia who had recently recovered from an episode of non-specific low back pain that was not attributed to a specific diagnosis, and which lasted for at least 24 h. Participants were randomly assigned to an individualised, progressive walking and education intervention facilitated by six sessions with a physiotherapist across 6 months or to a no treatment control group (1:1). The randomisation schedule comprised randomly permuted blocks of 4, 6, and 8 and was stratified by history of more than two previous episodes of low back pain and referral method. Physiotherapists and participants were not masked to allocation. Participants were followed for a minimum of 12 months and a maximum of 36 months, depending on the date of enrolment. The primary outcome was days to the first recurrence of an activity-limiting episode of low back pain, collected in the intention-to-treat population via monthly self-report. Cost-effectiveness was evaluated from the societal perspective and expressed as incremental cost per quality-adjusted life-year (QALY) gained. The trial was prospectively registered (ACTRN12619001134112). FINDINGS Between Sept 23, 2019, and June 10, 2022, 3206 potential participants were screened for eligibility, 2505 (78%) were excluded, and 701 were randomly assigned (351 to the intervention group and 350 to the no treatment control group). Most participants were female (565 [81%] of 701) and the mean age of participants was 54 years (SD 12). The intervention was effective in preventing an episode of activity-limiting low back pain (hazard ratio 0·72 [95% CI 0·60-0·85], p=0·0002). The median days to a recurrence was 208 days (95% CI 149-295) in the intervention group and 112 days (89-140) in the control group. The incremental cost per QALY gained was AU$7802, giving a 94% probability that the intervention was cost-effective at a willingness-to-pay threshold of $28 000. Although the total number of participants experiencing at least one adverse event over 12 months was similar between the intervention and control groups (183 [52%] of 351 and 190 [54%] of 350, respectively, p=0·60), there was a greater number of adverse events related to the lower extremities in the intervention group than in the control group (100 in the intervention group and 54 in the control group). INTERPRETATION An individualised, progressive walking and education intervention significantly reduced low back pain recurrence. This accessible, scalable, and safe intervention could affect how low back pain is managed. FUNDING National Health and Medical Research Council, Australia.
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Affiliation(s)
- Natasha C Pocovi
- Department of Health Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Chung-Wei Christine Lin
- The Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia; Sydney School of Public Health Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Petra L Graham
- Faculty of Medicine, Health and Human Sciences, and School of Mathematical and Physical Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia
| | - Johanna M van Dongen
- Department of Health Sciences, Vrije University of Amsterdam, Amsterdam, Netherlands
| | - Jane Latimer
- The Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia; Sydney School of Public Health Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Dafna Merom
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Anne Tiedemann
- The Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia; Sydney School of Public Health Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Christopher G Maher
- The Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia; Sydney School of Public Health Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Shuk Yin Kate Tong
- Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mark J Hancock
- Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
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